3-Dimensional computed tomographic angiography for use of surgery planning in patients with intracranial aneurysms
3-Dimensional computed tomographic angiography for use of surgery planning in patients with intracranial aneurysms
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DOI：
10.1007/s00701-005-0577-4
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发表时间：
2005-10-01
影响因子：
2.4
通讯作者：
Harders, A
中科院分区：
文献类型：
--
作者：
Pechlivanis, I;Schmieder, K;Harders, A
背景。在蛛网膜下腔出血（SAH）诊断评估的根本原因是必要的，因为再出血率高。本研究的目的是回答三维计算机断层血管成像（3D-CTA）是否能够准确确定颅内动脉瘤患者的手术指征。行3D-CTA后，分析动脉瘤的大小、动脉瘤圆顶的方向、颈部位置和威利斯圈的变异。在动脉瘤清晰可见的病例中，仅根据CTA数据进行手术。如果发现阴性或不确定，也可以进行动脉内数字减影血管造影（DSA）。在2001年1月至2002年12月期间，我们检查了100例患者（68例，32例），诊断出123个动脉瘤（86例破裂，37例未破裂）。所有患者术前均接受CTA治疗，27例患者在术前进行选择性DSA治疗。术后34例患者行DSA检查。100例患者中有92例CTA与术中发现有良好的相关性。一个动脉瘤在CTA上未被发现，但在DSA上被发现。在4例病例中，我们可以在重新评估数据后确认CTA的DSA发现。其中3例CTA和DSA均未明确显示动脉瘤，但在手术中得到证实。61例患者中有60例（98%）发现CTA和DSA具有良好的相关性。92例患者的CTA与术中表现的相关性如预期的那样好，其中5例患者在重新评估时发现动脉瘤。只有1例动脉瘤不能通过CTA显示，但dsa显示。与DSA相比，CTA侵入性小，耗时少，成本低，更容易显示动脉瘤的基本信息。因此，我们建议在仔细分析后，大多数动脉瘤（92%）可以仅根据CTA数据进行手术。
Background. After subarachnoid haemorrhage (SAH) diagnostic evaluation of the underlying cause is warranted since the rebleeding rate is high. The objective of the study was to answer the question, whether 3-Dimensional computed tomographic angiography (3D-CTA) is able to accurately determine the surgical indications in patients with intracranial aneurysms.Methods. After performing 3D-CTA the size of the aneurysm, direction of the aneurysmal dome, neck position and variants of the circle of Willis were analysed. Surgery was performed solely on CTA data in those cases, where the aneurysm was clearly visible. If the findings were negative or inconclusive, intra-arterial digital subtraction angiography (DSA) was also done.Findings. Between January 2001 and December 2002 100 patients (68 F, 32M) were examined and 123 aneurysms (86 ruptured and 37 unruptured) were diagnosed. All patients received CTA preoperatively and in 27 patients selective DSA was additionally performed. Postoperatively in 34 patients the operative result was checked by DSA. A good correlation between CTA and the intra-operative findings was present in 92 of 100 patients. One aneurysm was not seen on CTA, but was on DSA. In four cases we could confirm DSA findings in CTA after re-evaluation of the data. In three cases neither CTA nor DSA clearly showed an aneurysm, but it was confirmed during surgery.A good correlation between CTA and DSA was found in 60 of 61 patients (98%). The correlation between CTA and intra-operative findings was good as expected in 92 patients, in 5 patients an aneurysm was detected on re-evaluation. Only one aneurysm could not be demonstrated by CTA but in DSA.Conclusion. CTA is less invasive, less time consuming, cheaper and easier to demonstrate the essential information regarding the aneurysm than DSA. We therefore recommend that following a careful analysis most aneurysms -92%-can be operated solely on CTA data.