Impact of Cone-Beam Computed Tomography Angiography on Visualization of Sylvian Veins

BACKGROUND: A detailed understanding of the anatomy of Sylvian veins preoperatively is needed for venous-preserving Sylvian dissection. Better visualiza-tion of the venous architecture will facilitate surgical strategies for Sylvian dissection. This study evaluated and compared the image quality of the Sylvian veins and their tributaries using high-resolution cone-beam computed tomography angiography (CBCT-A) and threedimensional computed tomography angiography (3D-CTA).METHODS: Twenty-four patients who underwent 3DCTA and CBCT-A as a preoperative simulation for clipping of unruptured intracranial aneurysms were retrospectively reviewed. In comparisons with intraoperative inspections, 3 raters evaluated the image quality of the Sylvian veins by 3D-CTA and CBCT-A with a 5-point scale. Visualization of the Sylvian veins and their tributaries by the 2 imaging modalities was compared using Wilcoxon signed rank test.RESULTS: CBCT-A showed superior image quality to 3D-CTA in evaluations of the discrimination of adjacent superficial Sylvian veins (2.8 +/- 0.80 vs. 4.6 +/- 0.37, P < 0.0001), adjacent Sylvian veins at the sphenoid wing (3.1 +/- 0.71 vs. 4.1 +/- 0.56, P [ 0.0001), and visualization of the tributaries of the Sylvian veins (2.5 +/- 0.70 vs. 4.4 +/- 0.37, P < 0.0001).CONCLUSIONS: CBCT-A was superior to 3D-CTA for visualizing the Sylvian veins and their tributaries. CBCT-A will provide important information on the anatomy of the Sylvian veins preoperatively.