Research of the safety of multi-slice computer tomography angiography as the evaluative criteria before aneurismal microsurgical clipping / 中华急诊医学杂志

ABSTRACT

Objective To evaluate if MS-CTA can be the primary and sole evaluative criteria for the treatment of intracranial aneurysms by microsurgery clipping. Methods Between January 2008 and October 2010, 105 patients with intracranial aneurysm underwent microsurgery clipping in our institution were respectively analyzed, out of which 39 patients with preoperative MS-CTA (64- or 320-slice CT scanner) examinations (MS-CTA group) , 21 with MS-CTA combined with DSA and 45 with DSA ( DSA group). The aneurismal size, neck, morphous and peripheral branches were compared between the CTA data and operative results, and the concordance between which were analyzed. The rate of operative complication and the GOS scale at discharge were also compared between MS-CTA group and DSA group. t test, Chi-Square test or Rank test were used for analysis of the patients' baseline data, Kappa test for the concordance between MS-CTA and operative results, Kruskal-Wallis test for operative complication and Mann-whitney test for the GOS at discharge between MS-CTA group and DSA group. Results Thirty-seven patients out of the MS -CTA group obtained successful microsurgery clipping, with 1 transferred to coil embolization because of the difficulty in exposing the aneurismal neck and 1 to decompressive craniectomy because of aneurismal rebleeding at removal cranium. There was a good concordance between MS-CTA and operative results on depicting aneurysmal size and neck ( κ =0.726 ,κ =0. 756) and a ordinary concordance on morphous and peripheral branches ( κ =0.524, κ =0.473). There was no significant difference on the rate of operative complication (P =0.509) and GOS scale (P =0.239) at discharge. Conclusions MS-CTA can reveal the important characteristics of intracranial aneurysms, and has a high safety as being the primary and sole criteria before microsurgery clipping.