Cutting Edge of Micro‒vascular Anatomy in Neuroendovascular Therapy

In recent years, advances have been made in a variety of diagnostic imaging techniques, including three‒dimensional digital subtraction angiography（DSA）, slab maximum intensity projection（MIP）, and fusion imaging of DSA with MRI and CT. These advancements have allowed clinicians to more easily understand the functional micro‒vascular anatomy by clarifying the relationship between the brain, cranial nerves, and bone structures. Preoperative precise simulation using these techniques is beneficial not only for endovascular neurosurgeons, but also for general neurosurgeons. Herein, we introduce the use of these recent imaging techniques in our daily practice. We routinely performe three‒dimensional DSA and slab MIP imaging for the treatment of cerebrovascular disease. Preoperative simulation imaging is then performed using a fusion technique with DSA, MRI, or CT imaging. This regimen helps us to plan an accurate surgical strategy and perform safe surgery. Endovascular neurosurgeons, who have extensive knowledge regarding functional vascular anatomy and newly developed diagnostic modalities, may contribute to the strength of both open and endovascular neurosurgery.