We investigated the clinical usefulness of biplane rotational digital subtraction angiography (DSA) in comparison with anteroposterior and lateral biplane DSA for intracranial diseases including 11 patients with cerebral aneurysms, 11 with arteriovenous malformations (AVM) and 11 with brain tumors. By using a system equipped with crossed biplane X-ray tubes and 6/9/12 inch image intensifers supported on a C-arm that rotated through 90 degrees around the body axis during 7 seconds while acquiring digital images by 30 alternate pulse X-ray exposures per second from 2 directions, rotational DSA images of intracranial vessels from about 180 degrees in total were obtained by a one-shot infusion of iodinated contrast medium on a real-time basis. Biplane rotational DSA images were significantly superior to conventional biplane DSA images in terms of visualization of shape, direction, neck, bleb formation, and relationship with surrounding vessels in the cases of intracranial aneurysm, visualization of shape and relationship with surrounding vessels in the cases of AVM, and visualization of feeding arteries and relationship with surrounding vessels in the cases of brain tumor. Three-dimensional angiographic images with biplane rotational DSA were obtained by means of one-shot infusion of contrast medium and provided useful visualization of intracranial vessels from 180 degrees.