Document Detail


Benefits of clipping surgery based on three-dimensional computed tomography angiography.
MedLine Citation:
PMID:  20805644     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The recent development of three-dimensional computed tomography (3D-CT) angiography with multi detector row CT (MDCT) improves cerebral artery imaging due to faster scanning at thinner collimation over a large scanning volume. Aneurysm clipping was performed using only 3D-CT angiography created by MDCT with 16 detector arrays (16-MDCT angiography), in place of digital subtraction angiography (DSA) to evaluate the suitability of 16-MDCT angiography for preoperative examination before aneurysm clipping, and identify the essential points when making 3D images. Thirty-two patients with subarachnoid hemorrhage (SAH) identified by initial CT or with non-ruptured aneurysm were entered in this study. Twenty-six SAH patients underwent 3D-CT angiography, and aneurysms were treated by clipping (n = 25) or coil embolization (n = 4). One patient with no aneurysm depicted by 3D-CT angiography underwent conventional DSA twice subsequently. The sensitivity of 16-MDCT angiography to depict aneurysms in patients with SAH, and time between admission and entering the operating room were evaluated, and compared with those under the former protocol using DSA. The sensitivity of 16-MDCT angiography for aneurysm detection was 100%. Shapes of all aneurysms depicted by 3D-CT angiography were validated intra-operatively. The mean operation waiting time was 2.8 hours, with the shortest time being 1.5 hours. Re-bleeding occurred in one of the 20 patients. We conclude that shorter preoperative waiting time decreased the incidence of premature re-bleeding, resulting in better outcomes. We highly recommend that the surgeon sets the threshold value, and rotates the 3D image to establish better surgical orientation.
Authors:
Mutsumi Nagai; Eiju Watanabe
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Neurologia medico-chirurgica     Volume:  50     ISSN:  1349-8029     ISO Abbreviation:  Neurol. Med. Chir. (Tokyo)     Publication Date:  2010  
Date Detail:
Created Date:  2010-08-31     Completed Date:  2011-01-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400775     Medline TA:  Neurol Med Chir (Tokyo)     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  630-7     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Sano Kousei General Hospital, Sano, Tochigi, Japan. mnagai@jichi.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aneurysm, Ruptured / complications,  surgery
Cerebral Angiography / instrumentation,  methods*
Cerebral Arteries / radiography,  surgery*
Embolization, Therapeutic / methods
Female
Humans
Imaging, Three-Dimensional*
Intracranial Aneurysm / complications,  surgery*
Male
Middle Aged
Neurosurgical Procedures / instrumentation,  methods
Radiographic Image Enhancement
Sensitivity and Specificity
Subarachnoid Hemorrhage / etiology,  surgery*
Surgical Instruments
Tomography, X-Ray Computed / instrumentation,  methods
Treatment Outcome
Vascular Surgical Procedures / instrumentation,  methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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