Current usage of three-dimensional computed tomography angiography for the diagnosis and treatment of ruptured cerebral aneurysms
Kenichi Amagasaki MD, Nobuyasu Takeuchi MD, Takashi Sato MD, Toshiyuki Kakizawa MD, Tsuneo Shimizu MD Kanto Neurosurgical Hospital, Kumagaya, Saitama, Japan
Summary Our previous study suggested that 3D-CT angiography could replace digital subtraction (DS) angiography in most cas of ruptured cerebral aneurysms, especially in the anterior circulation. This study reviewed our further experience. One hundred and fifty patients with ruptured cerebral aneurysms were treated between November 1998 and March 2002. Only
3D-CT angiography was ud for the preoperative work-up study in patients with anterior circulation aneurysms, unless the attending neurosurgeons agreed that DS angiography was required.
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Both 3D-CT angiography and DS angiography were performed in patients with posterior circulation aneurysms, except for recent cas that were possibly treated with 3D-CT angiography alone. One hundred sixteen (84%) of 138 patients with ruptured anterior circulation aneurysms underwent surgical treatment, but additional DS angiography was required in 22
cas (16%). Only two recent patients were treated surgically with 3D-CT angiography alone in 12 patients with posterior circulation aneurysms. Most patients with ruptured anterior circulation aneurysms could be treated successfully after 3D-CT angiography alone. However, additional DS angiography is still necessary in atypical cas. 3D-CT angiography may be limited to complementary u in patients with ruptured posterior circulation aneurysms.
a 2003 Elvier Ltd. All rights rerved.
Keywords: 3D-CT angiography, cerebral aneurysm, subarachnoid haemorrhage, surgery
INTRODUCTION
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Recently, three-dimensional computed tomography (3D-CT) angiography has become one of the major tools for the identification of cerebral aneurysms becau it is faster, less invasive, and more convenient than cerebral angiography.1–7 Patients with ruptured aneurysms could be treated under diagnos bad on only 3D-CT angiography.5;6 3D-CT angiography has some limitations for the preoperative work-up for ruptured cerebral aneurysms, so additional digital subtraction (DS) angiography is still necessary, especially for aneurysms in the posterior circulation.8 Our previous study suggested that 3D-CT
angiography could replace DS angiography in most patients with ruptured cerebral aneurysms in the anterior circulation.1 This study reviewed our experience of treating ruptured cerebral aneurysms in the anterior and posterior circulations bad on
3D-CT angiography in 150 concutive patients to asss the current usage of 3D-CT angiography.
METHODS AND MATERIAL
Patient population
We treated 150 patients, 60 men and 90 women aged from 23 to 80 years (mean 57.5 years), with ruptured cerebral aneurysm identified by 3D-CT angiography between November 1998 and March 2002.
Managementof cas
The prence of nontraumatic subarachnoid haemorrhage (SAH) was confirmed by CT or lumbar puncture findings of xanthochromic cerebrospinal fluid. 3D-CT angiography was performed routinely in all patients. DS angiography was performed in patients with anterior circulation aneurysms only if additional information was considered necessary following a connsus interpretation of the initial C怎样治疗口臭
T and 3D-CT angiography by four neurosurgeons. Patients with ruptured aneurysms in the posterior circulation underwent both 3D-CT angiography and DS兵不厌诈的意思
angiography except for two recent patients with typical vertebral arteryposterior inferior cerebellar artery (VA-PICA) aneurysm. Typical saccular aneurysms were treated by clipping surgery. Fusiform and discting aneurysms were treated by proximal occlusion by either surgery or endovascular treatment with or without bypass surgery. Regrowth of bleeding aneurysms was treated by either surgery or endovascular treatment. Postoperatively, all patients were managed with aggressive prevention and treatment of vasospasm including intra-arterial infusion of papaverine or transluminal angioplasty.
貂蝉故里
蝴蝶兰开完花后怎么处理方法3D-CT angiography acquisition and postprocessing CT angiography was performed with a spiral CT scanner (CT-W 3000 AD; Hitachi, Ibaraki, Japan). Acquisition ud a standard technique starting at the foramen magnum, with injection of 130 ml of nonionic contrast material (Omnipaque; Daiichi Pharmaceutical,Tokyo, Japan). The source images of each scan were transferred to an off-line computer workstation (VIP station; Teijin System Technology, Japan). Both volume-rendered images and maximum intensity projection images of the cerebral arteries were constructed. The anterior circulation and posterior circulation were evaluated parately on the volume-rendered images, after
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a general superior view was obtained. The anterior
circulation was evaluated by first obrving the anterior communicating artery (ACoA) by rotating the view, and then each side of the carotid system by rotating the image with editing out of the contralateral carotid artery. The posterior circulation was also evaluated by rotating the image but without editing out of any vesl. Once a possible rupture site was found, the view was zoomed and cloly rotated with the other vesls edited out. Theaneurysm size was measured on 3D-CT angiography as the larger of the length of the dome or the width of the neck. Manipulation was performed by the scanner technician, with a neurosurgeon to provide editing assistance.
放肆造句DS angiography acquisition
Standard lective three- or four-vesl DS angiograms with frontal, lateral, and oblique projections were obtained. The 3D-CT angiogram was always available as a guide for possible additional DS angiography projections. Aneurysm size was measured with DS angiography when the quality of 3D-CT angiography was inadequate. All patients except elderly patients or patients in vere condition underwent DS angiography postoperatively. Grading of patients
The clinical conditions of the patients at admission were classified according to the Hunt and Kosnik
grade.9 Clinical outcome was
