Using of three dimensional volume rendering angiography in the determination of vessel-free areas of the scalp in the patients underwent intracranial aneurysm surgery during the placement of three-pins metallic head fixation device

Three-pins head holder device has been safely used for many years in many neurosurgical procedures for providing 3-point rigid cranial fixation. Equal impingement of pins ensures firm skull positioning and fixation after carefully positioning of skull pins around the vessel free areas. The raw data of the three-dimensional computerized tomography angiography (3D-CTA) obtained from the patients with subarachnoid hemorrhage were transferred to computer and recorded in a software program. This software program created three-dimensional images of skull using previously transferred raw data with volume rendering technique. Safe areas for pins placement, in terms of vessel-free areas, were determined using three-dimensional volume rendering angiography of the skull. The study group consists of 53 (27 female and 26 male) patients. The mean age of the patients was estimated as 57.9±9.7 years. Branches, distribution and critical anastomosis of the superficial temporal artery were also determined. In the other way, the course of the posterior auricular and occipital artery ascending along the external surface of the mastoid bone was also detected in all cases. In the patients underwent surgery for intracranial aneurysm, using of three-dimensional volume rendering angiography may be used in the determination of vessel-free areas of the external surface of the scalp during the placement of three-metallic pins of head holder device.