Correlación de los hallazgos panangiográficos, angiotomográficos y transoperatorios de los aneurismas intracraneales / Correlation of angiography and angiotomography results and transoperatory surgical finding in intracranial aneurysms

Objetivo: Determinar la correlación de la angiografía de sustracción digital y la angiotomografía con los hallazgos transoperatorios en el diagnóstico de los aneurismas intracraneales. Material y métodos: Este estudio se realizó en el Hospital de Especialidades Centro Médico Nacional La Raza del IMSS, del 1 de diciembre del 2003 al 31 de mayo del 2004, estudiándose un total de 20 pacientes con diagnóstico de aneurisma intracraneal roto o no roto que contara con ambos estudios de imagen: angiotomografía tridimensional y panangiografía cerebral y que recibiera tratamiento quirúrgico. Posteriormente los estudios de imagen se correlacionaron con los hallazgos transoperatorios. Resultados: La localización del aneurisma concordó con los hallazgos quirúrgicos en 100% de los casos por angiografía y 96% por angiotomografía, el tamaño del aneurisma fue 92% por angiografía y 84% por angiotomografía, características del cuello 92% por angiografía y 84% por angiotomografía, relación con arterias adyacentes 96% por angiografía y 88% por angiotomografía, la orientación del domo del aneurisma fue correcta en 100% con los dos estudios. Conclusiones: Los resultados obtenidos en base a la angiotomografía son alentadores, sin embargo sigue existiendo poca disponibilidad en nuestro Hospital para la realización de este estudio con miras a ser el estudio de elección. Deberán mejorarse las técnicas para el procesamiento de las imágenes para realizar a futuro la planeación quirúrgica de los aneurismas en base a la angiotomografía 3D .

Objective: Determine the correlation of angiography and angiotomography imaging results with transoperative findings in the diagnosis of intracranial aneurysms. Material and methods: The study took place at the <> from December 2003 through May 31 2004. We studied 20 patients who underwent surgical treatment due to ruptured or non ruptured intracranial aneurysm and had angiotomography and cerebral angiography. Imaging studies were later correlated with surgical findings. Results: Aneurysm location matched surgical findings in 100% of cases with angiography and 96% with angiotomography. Aneurysm size matched surgical findings in 92% of cases with angiography and 84% with angiotomography. The neck's characteristics matched 92% with angiography and 84% with angiotomography. The relationship of the aneurysm with adjacent arteries correlated in 96% of cases with angiography and 88% with angiotomography. The aneurysm s dome direction had a 100% match in both studies. Conclusions: 3D angiotomography results in our study showed an important correlation with surgical findings. While our results are encouraging, this procedure is not readily available at our facility and therefore cannot be considered the optimum imaging study. We must improve image processing, and train staff to include angiotomography in future surgical management of aneurysms.

Prognosis of Primary Subarachnoid Hemorrhage

A clinical analysis and follow-up study were performed with 35 cases of subarachnoid hemorrhage of unknown etiology among 217 cases of spontaneous subarachnoid hemorrhage who were diagnosed by cerebral pan-angiohraphy and brain C-T scan and treated at department of neurosurgery, Chonju Presbyterian Medical Center from 1977 to 1982. The duration of follow-up study was 6 months to 8 years(mean 4.4years). The author obtained the following results. 1) Subarachnoid hemorrhage of unknown etiology was 16% of 217 cases of spontaneous hemorrhage. 2) The incidence of subarachnoid hemorrhage of unknown etiology was high in 5th decade and higher in women. 3) Manifestations of subarachnoid hemorrhage of unknown etiology were similar to those of ruptured aneurysm. 4) When primary cerebral pan-angiography was normal, the secondary cerebral pan-angiography was not so meaningful. 5) The overall prognosis of the cases of unknown etiology was good in 30 among 35 cases(86%) who were able to return to their previous occupation. 6) Age and blood pressure were probably major prognostic factor.