Matsumoto M, Sato M, Nakano M, Endo Y, Watanabe Y, Sasaki T, Suzuki K, Kodama N
Department of Neurosurgery, Fukushima Medical School, Japan.
J Neurosurg. 2001 May;94(5):718-27. doi: 10.3171/jns.2001.94.5.0718.
The aim of this study was to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography (3D-CT) angiography alone, without conventional catheter angiography.
In a previous study, 60 patients with subarachnoid hemorrhage (SAH) from ruptured aneurysms were prospectively evaluated using both 3D-CT and conventional angiography, which resulted in a 100% accuracy for 3D-CT angiography in the diagnosis of ruptured aneurysms, and a 96% accuracy in the identification of associated unruptured aneurysms. The results led the authors to consider replacing conventional angiography with 3D-CT angiography for use in diagnosing ruptured aneurysms, and to perform surgery aided by 3D-CT angiography alone without conventional angiography. Based on the results, 100 consecutive patients with SAH who had undergone surgery in the acute stage based on 3D-CT angiography findings have been studied since December 1996. One hundred ruptured aneurysms, including 41 associated unruptured lesions, were detected using 3D-CT angiography. In seven of 100 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA-superior cerebellar artery aneurysm, 3D-CT angiography was followed by conventional angiography to acquire diagnostic confirmation or information about the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. Ninety-three patients who underwent operation with the aid of 3D-CT angiography only had no complications related to the lack of information gathered by conventional angiography. The 3D-CT angiography studies provided the authors with the aneurysm location as well as surgically important information on the configuration of its sac and neck, the presence of calcification in the aneurysm wall, and its relationship to the adjacent vessels and bone structures.
The authors believe that 3D-CT angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.
本研究旨在评估对于破裂性脑动脉瘤患者，能否仅使用三维计算机断层扫描（3D-CT）血管造影而不进行传统导管血管造影来实施动脉瘤手术。
在之前的一项研究中，对60例因动脉瘤破裂导致蛛网膜下腔出血（SAH）的患者同时进行了3D-CT和传统血管造影的前瞻性评估，结果显示3D-CT血管造影对破裂性动脉瘤的诊断准确率为100%，对相关未破裂动脉瘤的识别准确率为96%。这些结果使作者考虑用3D-CT血管造影取代传统血管造影用于诊断破裂性动脉瘤，并仅在3D-CT血管造影辅助下进行手术而不进行传统血管造影。基于这些结果，自1996年12月起，对100例基于3D-CT血管造影结果在急性期接受手术的SAH患者进行了研究。使用3D-CT血管造影检测到100个破裂性动脉瘤，其中包括41个相关的未破裂病变。在100个破裂性动脉瘤中的7个，包括4个椎动脉夹层动脉瘤、2个基底动脉（BA）尖部动脉瘤和1个BA-小脑上动脉动脉瘤，在3D-CT血管造影后进行了传统血管造影，以获得诊断确认或获取有关Labbe静脉的信息，这对于指导BA尖部动脉瘤的手术入路是必要的。所有破裂性动脉瘤均在手术中得到确认并成功治疗。仅在3D-CT血管造影辅助下进行手术的93例患者没有出现与缺乏传统血管造影所收集信息相关的并发症。3D-CT血管造影研究为作者提供了动脉瘤的位置以及关于其瘤囊和瘤颈形态、动脉瘤壁钙化情况、以及它与相邻血管和骨结构关系等重要的手术信息。
作者认为3D-CT血管造影在诊断破裂性动脉瘤方面可以取代传统血管造影，并且几乎所有急性破裂性动脉瘤仅使用3D-CT血管造影而不进行传统血管造影即可进行手术。
