Roadmapping technique in the hybrid operating room for the microsurgical treatment of complex intracranial aneurysms.

OBJECTIVE: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. METHODS: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. RESULTS: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. CONCLUSIONS: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.

Prediction of Mechanical Properties and Subjective Consistency of Meningiomas Using T1-T2 Assessment Versus Fractional Anisotropy.

OBJECTIVE: This study aims to evaluate quantitatively the mechanical properties of meningiomas and their correlation with the qualitative surgeon's assessment of consistency, as well as comparing the capability to predict tumor consistency of fractional anisotropy values calculated from the diffusion tensor imaging and T1/T2 signal intensities. METHODS: Sixteen patients with the diagnosis of intracranial meningioma were included. Fractional anisotropy values were calculated and T1/T2 assessment was performed. The qualitative assessment of the tumor consistency intraoperatively was determined by a neurosurgeon and quantitative assessment was obtained with the Warner-Bratzler mechanical test. RESULTS: Surgeon's qualitative assessment was concordant with the cutting force obtained from the mechanical tests (P = 0.046). There was a high correlation between tumor consistency reported by the surgeon and T1/T2 assessment (0.622/P = 0.01) and a moderate correlation with cutting force (0.532/P = 0.034) and elasticity (0.49/P = 0.05). Fractional anisotropy values for hard tumors were not significantly higher than for soft tumors (P = 0.115). There was no significant correlation between the fractional anisotropy and mechanical measurements (0.192/P = 0.3). Predictions of hard consistency in meningiomas were obtained with a sensitivity of 25% and a specificity of 100% when using the T1/T2 assessment and a sensitivity of 87.5% and a specificity of 50% when using the fractional anisotropy value. CONCLUSIONS: Qualitative surgeon's assessment was in accordance with measured mechanical properties. Fractional anisotropy value was not an independent predictor for tumor consistency and was not correlated with the mechanical tests results. T1/T2 assessment was correlated with mechanical properties and it can be used to discriminate very hard or soft tumors.