Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography
Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography
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DOI：
10.1007/s007010170045
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发表时间：
2001-01-01
影响因子：
2.4
通讯作者：
Feliu-Tatay, RA
中科院分区：
文献类型：
--
作者：
González-Darder, JM;Pesudo-Martínez, JV;Feliu-Tatay, RA
客观的。研究仅利用计算机断层扫描血管造影和三维重建（3D-CTA）提供的术前信息对破裂的颅内动脉瘤进行显微外科治疗的可能性。方法。诊断蛛网膜下腔出血后，对患者进行 3D-CTA 研究。如果研究质量足够，并且发现动脉瘤与临床发现或神经学检查和/或计算机断层扫描 (CT) 扫描上的出血位置一致，则可以对病变进行早期显微手术夹闭。当 3D-CTA 研究的质量不够，或者质量足够但未显示病变，或者结果不够准确，无法保证直接显微外科治疗时，则对患者进行脑数字减影 (DS) 血管造影研究。共有 44 名连续患者接受显微外科夹闭术，并纳入该研究，这些患者经 3D-CTA 诊断出总共 47 个颅内动脉瘤，且未进行术前 DS 血管造影。结果。总死亡率为15.9%，出院后6个月通过格拉斯哥结果量表评估的良好结果达到70.4%。所有病灶均被成功夹闭。入院出血平均 4.1 天后进行手术。手术中总共发现了四个未通过 3D-CTA 诊断的微病变并进行了切除。术后 DS 血管造影和尸检结果也用作 3D-CTA 结果的对照，但除了 DS 血管造影中发现无症状海绵体内动脉瘤外，没有提供其他信息。因此3D-CTA诊断症状性动脉瘤的敏感性为100%，总体敏感性为90.4%。结论。我们在接受或不接受术前血管造影的患者中得到了类似的结果。 3D-CTA 提供了非常有价值的解剖信息，这对于前交通动脉复合体动脉瘤的显微外科治疗具有附加价值。最后，通过 3D-CTA 提供的术前信息，无需 DS 血管造影即可成功治疗选定的颅内动脉瘤破裂病例。
Objective. To study the posibilities of the microsurgical management of ruptured intracranial aneurysms with the sole preoperative information provided by computed tomography angiography with three-dimensional reconstruction 3D-CTA).Methods. Patients were studied with 3D-CTA after diagnosis of subarachnoid hemorrhage. If the study had an adequate quality and revealed an aneurysm congruent with the clinical findings or neurological examination and/or with the location of the bleeding on computed tomography (CT) scan an early microsurgical clipping of the lesion was done. When the quality of the 3D-CTA study was not adequate or the quality being adequate displayed no lesions or the findings were not accurate enough to warrant direct microsurgical treatment, the patient was studied with cerebral digital substraction (DS) angiography. A total of 44 consecutive patients harbouring a total of 47 intracranial aneurysms diagnosed by 3D-CTA and without preoperative DS angiography were submitted to microsurgical clipping and included in the study.Results. The overall mortality was 15.9% and the favourable results evaluated 6 months after discharge by means of the Glasgow Outcome Scale reached 70.4%. All lesions were successfully clipped. Surgery was done a mean of 4.1 days after the admission bleeding. A total of four microlesions undiagnosed by 3D-CTA were found at surgery and clipped. Postoperative DS angiography and necropsy findings were also used as control of the 3D-CTA findings but no additional information was provided excepting the finding in DS angiography of an asymptomatic intracavernous aneurysm. Therefore the sensitivity of the 3D-CTA for diagnosis of symtomatic aneurysms was 100% and the overall sensitivity 90.4%,Conclusions. We have reached similar results in patients operated on with or without preoperative angiography. 3D-CTA provides very valuable anatomical information, which has an additional value in the microsurgical treatment of aneurysms of the anterior communicating artery complex. Finally, selected cases of ruptured intracranial aneurysms can be successfully managed with the preoperative information provided by 3D-CTA and without DS angiography.