The comparison of neuronavigation combined with CT three-dimensional angiography vs. CT angiography in the guidance of clipping treatment in distal intracranial aneurysm surgery: a retrospective clinical study.

Background: Distal intracranial aneurysms are often located deep in the lateral or longitudinal fissure pool or brain parenchyma, lacking a fixed anatomical location. Precise intraoperative localization of distal intracranial aneurysms is a problem that plagues neurosurgeons. Studies have shown that neuronavigation and Computed Tomography (CT) three-dimensional angiography can significantly improve the accuracy of intracranial aneurysm surgery. However, their values in the distal intracranial aneurysm surgery remain unknown. The objective of this study was to explore the application value of neuronavigation combined with CT three-dimensional angiography in distal intracranial aneurysm surgery. Methods: 112 patients admitted to our hospital for intracranial distal aneurysm surgery were retrospectively collected and divided into an observation group (n=51) and a control group (n=61) according to the surgical method received by the patients. The observation group underwent clipping treatment based on neuronavigation combined with CT three-dimensional angiography, and the control group received clipping treatment under the guidance of CT angiography. Both groups were observed for the accuracy of localization and approach design, duration of surgery, intraoperative bleeding volume, Glasgow Outcome Scale (GOS), National Institute of Health Stroke Scale (NIHSS), length of hospital stay, and complications. Results: Compared with the control group, the localization accuracy of patients in the observation group was significantly increased (94.12% vs. 78.69%, P=0.020), and the accuracy of approach design was markedly improved (90.20% vs. 72.13%, P=0.017). Furthermore, the length of hospital stay in the observation group was notably reduced compared with the control group (8.12±2.12 vs. 8.99±1.87 d, P=0.023). There was no statistical difference in the NIHSS scores between the two groups before treatment and at 3 days after treatment (P>0.05). However, compared with the control group, the NIHSS score was significantly reduced in the observation group at 28 days after surgery (4.10±2.48 vs. 6.30±3.20, P=0.000). There were no statistically significant postoperative complications in either group (P>0.05). Conclusions: Neuronavigation combined with CT three-dimensional angiography can enhance the accuracy of localization and approach design in intracranial distal aneurysm surgery, improve patient nerve function, and is worth promoting.

Relationship of stylohyoid chain and cervical internal carotid artery detected by 3D angiography.

OBJECTIVE: The calcification of the stylohyoid chain (SHC), elongated styloid process (SP), larger SP' angle and its shortened distance of cervical internal carotid artery (CICA) are risk factors for bony compression and the stylocarotid syndrome. METHODS: 3D-CTAs of 125 patients were analyzed in terms of the SP length, its angulations, type of the SHC and relationships of its proximity to the CICA. RESULTS: Elongated SP was observed frequently both in females (47%) and males (55%). The mean distance of the CICA to the SP was calculated as 8.2 ± 3.3 mm. This short distance between the CICA and the SP was observed more frequently in males (28.1%) and females (10.7%). The anterior and medial angulations of the SP were calculated as 71.2 ± 4.3°, and 57.3 ± 9.3°, respectively. In the present study, the SHC was determined as normal SP (54.2%), absence of the SP (1%), duplication of the SP (1%), elongated SP (26%), complete ossification of the SHC (1%), segmentation of the SHC (9%), fracture of ossification of the SHC (1.6%) and pseudo articulations of the SHC (5.6%). CONCLUSION: 3D-CTA was the most appropriate radiological investigation analyzing and measuring SHC (elongated, larger angle, shorter distances with CICA) and identifying types (duplicated, segmented, complete and fractured) resulting from pressures on the CICA. Our study also revealed the pressure on the artery not only arose from the tip of the SP but could also result from types stretching over the artery wall. In those specimens, there is a higher probability of formation of the stylocarotid syndrome due to the long-term pressure on the sympathetic chain around the CICA.

An extremely rare case report of surgery of lung cancer with the absence of azygos vein.

In thoracic surgery, we occasionally encounter vessel anomalies. We herein report an extremely rare surgical case with the absence of the azygos vein. Mediastinal vascular abnormalities are said to be rare. The etiology of vascular abnormalities of the whole body, including the chest is known gene mutations, hormone abnormalities, infection, and trauma. But, many causes have been unknown. In thoracic surgery field, there is some reports and literature about pulmonary arteriovenous malformation, pulmonary sequestration, and partial anomalous pulmonary venous return. But reports about absence of azygos vein are not much. It is considered that it is less likely to become a problem in clinical. As we discussed in the paper, it will be more interesting if the association with PLSVC reveals from more cases. A 58-year-old man was admitted to our hospital in order to undergo operation for the treatment of lung cancer. We detected absence of the azygos vein by preoperative computed tomography (CT). Furthermore, three-dimensional angiography (3D-angiography) showed that the right superior intercostal vein and hemiazygos vein in the left thoracic cavity were more developed than usual. Then, we discuss the key points during surgery and suggest the potential association between the absence of the azygos vein and a persistent left superior vena cava (PLSVC).

Three-dimensional angiographic demonstration of plexiform fenestrations of the proximal anterior cerebral artery associated with a ruptured aneurysm.

A rare case of ruptured aneurysm associated with multiple A(1) fenestrations resembling plexiform network was demonstrated by 3D angiography. A 56-year-old female presented with a ruptured aneurysm in the A(2) segment of the left distal anterior cerebral artery associated with the right A(1) fenestration. The ruptured aneurysm was occluded with surgical neck clipping via interhemispheric approach without neurological deficit. Plexiform fenestrations of the right distal A(1), opposite side to the left ruptured A(2) aneurysm, were clearly visible on postoperative 3D angiography. Our case may strongly support the theory described by Paget, namely that a remnant of the plexiform anastomosis between the primitive olfactory artery and A(1) segment is the source of such fenestration.

Three-Dimensional Angiographic Demonstration of Plexiform Fenestrations of the Proximal Anterior Cerebral Artery Associated with a Ruptured Aneurysm

A rare case of ruptured aneurysm associated with multiple A1 fenestrations resembling plexiform network was demonstrated by 3D angiography. A 56-year-old female presented with a ruptured aneurysm in the A2 segment of the left distal anterior cerebral artery associated with the right A1 fenestration. The ruptured aneurysm was occluded with surgical neck clipping via interhemispheric approach without neurological deficit. Plexiform fenestrations of the right distal A1, opposite side to the left ruptured A2 aneurysm, were clearly visible on postoperative 3D angiography. Our case may strongly support the theory described by Paget, namely that a remnant of the plexiform anastomosis between the primitive olfactory artery and A1 segment is the source of such fenestration.

Application of Dual-phase Multi-Slice Spiral CT Three-Dimensional Vascular Imaging Lesions in Liver Pathological Changes / 医疗卫生装备

Objective To evaluate the multi-slice spiral CT scan of liver dynamic dual-phase three-dimensional vascular imaging portal phase clinical value. Methods 80 cases in clinic, who were patients with liver function and imaging diagno- sis of liver and portal hypertension in liver cirrhosis, and 20 cases of healthy persons were carried out multi-slice spiral CT dual-phase scanning. The workstation used volume rendering techniques (VR) and maximum density multi-planar recon- struction technique for reconstruction. Results The hepatic arterial phase VR image and MIP MPR images can clearly show the celiac trunk, splenic artery, hepatic artery or artery and its branches, including 2-3 grade tumor blood supply variation of blood vessels and blood vessels, the portal venous phase, VR images and MIP MPR images clearly show the 1-6 level structure and the portal vein and hepatic vein branches of 1-3, with strong three-dimensional sense of space. Conclusion The multi-slice spiral CT three-dimensional reconstruction of portal vein imaging is a fast and effective non-invasive an- giography techniques, contributing to the clinical choice of reasonable efficacy of treatment programs and follow-up.

Diagnosis and Treatment of Intracranial Aneurysms with 3-dimensional Digital Subtraction Angiography / 대한뇌혈관학회지

OBJECTIVES: To evaluate the diagnostic accuracy of three-dimensional digital subtraction angiography in the surgical or interventional treatment of intracranial aneurysms. MATERIAL AND METHODS: We reviewed the clinical records, radiological findings, and surgical results of seventy-two patients with eight-five aneurysms who had undergone 2-dimensional digital subtraction angiography (2-D DSA) and 3-D DSA as the diagnostic evaluation. 3-D images were compared with 2-D images and surgical or interventional results. The shape of the aneurysms, their necks, and their relationships to the parent vessels and other branches were evaluated. RESULTS: The existence of the aneurysms was diagnosed exclusively by 3-D DSA in 13 patients. The site (n=27) and the shape (n=15) of the aneurysms were evaluated more accurately with 3-D DSA than with 2-D DSA images. Depiction of aneurysmal necks and their relationships to the parent vessels was clearer with 3-D DSA images than with 2-D DSA images, especially in cases of the distal internal carotid artery aneurysms. CONCLUSION: With its advantages, such as unlimited projection, similarity to surgical view, and high resolution especially in the cavernous portion of ICA, the 3-D DSA provides more valuable information in the planning the surgical or interventional treatments of cerebral aneurysms.

Assessment of Coronary Artery Bypass Graft Patency Using Three Dimensional Coronary Angiography by Electron Beam Tomography

BACKGROUNDS: The development of a noninvasive, accurate imaging technique for assessing coronary artery bypass graft patency is of major clinical importance because increasing numbers of patients have undergone coronary artery bypass surgery. The electron beam tomography, by virtue of its rapid data acquisition time and good spatial resolution, may be useful in this regard. The purpose of this study is to determine the accuracy of three-dimensional coronary angiography by electron beam tomography (EBT) in the assessment of patency of coronary artery bypass grafts. METHODS: Twenty-five patients who had undergone coronary artery bypass graft surgery were included. All patients underwent EBT and conventional coronary angiography for the evaluation of the status of bypass grafts. Three dimensional reconstruction of the heart and bypass grafts were performed and compared with selective angiography of the bypass grafts. RESULTS: Fifty-seven saphenous vein grafts (SVG) and 22 left internal mammary artery (LIMA) were evaluated for occlusion or patency. The sensitivity and specificity of EBT in the evaluation of LIMA patency were 80%, 82.4%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG patency were 91.7% and 91.1%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG according to the coronary territory were : 1) SVG to left anterior descending artery 100%, 100%:2) SVG to diagonal branch 100%, 100%:3) SVG to left circumflex artery 100%, 88.9%:4) SVG to right coronary artery 75%, 85.7%. CONCLUSION: Three-dimensional coronary angiography by electron beam tomography is a promising, useful and relatively accurate diagnostic technique for the evaluation of graft patency in patients who had undergone coronary artery bypass graft surgery.

Assessment of Coronary Artery Bypass Graft Patency Using Three Dimensional Coronary Angiography by Electron Beam Tomography

BACKGROUNDS: The development of a noninvasive, accurate imaging technique for assessing coronary artery bypass graft patency is of major clinical importance because increasing numbers of patients have undergone coronary artery bypass surgery. The electron beam tomography, by virtue of its rapid data acquisition time and good spatial resolution, may be useful in this regard. The purpose of this study is to determine the accuracy of three-dimensional coronary angiography by electron beam tomography (EBT) in the assessment of patency of coronary artery bypass grafts. METHODS: Twenty-five patients who had undergone coronary artery bypass graft surgery were included. All patients underwent EBT and conventional coronary angiography for the evaluation of the status of bypass grafts. Three dimensional reconstruction of the heart and bypass grafts were performed and compared with selective angiography of the bypass grafts. RESULTS: Fifty-seven saphenous vein grafts (SVG) and 22 left internal mammary artery (LIMA) were evaluated for occlusion or patency. The sensitivity and specificity of EBT in the evaluation of LIMA patency were 80%, 82.4%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG patency were 91.7% and 91.1%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG according to the coronary territory were : 1) SVG to left anterior descending artery 100%, 100%:2) SVG to diagonal branch 100%, 100%:3) SVG to left circumflex artery 100%, 88.9%:4) SVG to right coronary artery 75%, 85.7%. CONCLUSION: Three-dimensional coronary angiography by electron beam tomography is a promising, useful and relatively accurate diagnostic technique for the evaluation of graft patency in patients who had undergone coronary artery bypass graft surgery.