Three-dimensional CT angiography simulates operative approaches for intracranial aneurysms / 第二军医大学学报

ABSTRACT

Objective: To simulate the surgical approaches for intracranial aneurysms using three-dimensional CT angiography (3D-CTA) ,so as to assess the value of 3D-CTA in the microneurosurgery for ruptured intracranial aneurysms. Methods1 Totally 134 patients with spontaneous subarachnoid hemorrhage caused by ruptured intracranial aneurysm were confirmed by operation. All the patients were examined by CTA before operation and surgical simulation was conducted. Some patients were examined by the pre-operative DSA (digital subtract angiography). The findings of pre-operation CTA,DSA and intra-operative findings were compared and the clinical value of cerebral 3D-CTA was analyzed. Results1 3D-CTA discovered 162 aneurysms out of a total of 163 in 134 patients. The sensitivity and specificity of 3D-CTA for diagnosis of ruptured intracranial aneurysm were 99. 4% and ioo% , respectively. Moreover, pre-operation examination with 3D-CTA clearly displayed the location,size, and shape of aneurysms, the axis direction of the aneurysmatic summits and the width of aneurysmatic neck. Furthermore,the spatial relations between the parent aneurysm artery, the aneurysm, the periphery vessel and bony structures were also demonstrated. These findings were in accordance with the intra-operative findings. There was no rupture during exploration. The Glasgow outcome score was 5 in 85 patients,4 in 22,3 in 17,2 in 6,and 1 in 4. Conclusion1 The conventional pre-operative 3D-CTA examination can simulate surgery for patients with ruptured intracranial aneurysms, and it can help to design the operative approach and improve the successful rate of operation.