3D-CTA術前診断による破裂脳動脈瘤手術
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概要
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Recently, three-dimensional CT angiography (3D-CTA) is routine and useful examination before aneurysmal surgery, coupled with digital subtraction angiography (DSA). We believe 3D-CTA may show enough anatomical information for most ruptured aneurysmal surgeries. In this study, the surgery was performed using 3D-CTA without DSA. Between May 1997 and December 1999, 67 patients of SAH (total 78 aneurysms: 64 ruptured aneurysms, 14 unruptured aneurysms) were explored by 3D-CTA. A helical acquisition was performed for computed tomographic scans obtained with a bolus injection of non-ionic contrast medium on Toshiba X vigor/Real. It took only 15 minutes to get the final 3D films in our system. Examination by 3D-CTA showed 63 cases (94%) clearly developed aneurysms. Three cases were false positive. One of those aneurysms was suspected of being BA top AN. Another was IC-PC AN. The third was AcomA AN. But we could not find those aneurysms in the surgery. We diagnosed those cases as "Unknown SAH." One case was false negative. The aneurysm located on the distal PICA (1.5%) could not be detected because it was out of the image. In 98.4% of the patients, it was retrospectively though to be possible to perform safe operations with information from 3D-CTA. In 1 case 3D-CTA but not DSA detected MCA aneurysms. In the acute phase of subarachnoid hemorrhage, we could get the information quickly in the severe cases such as Grade IV or V. But 1 aneurysm of MCA reruptured during 3D-CTA due to lack of sedation. 3D-CTA was fast and a mostly safe examination. We concluded that it was possible to perform most ruptured aneurysmal surgeries successfully using 3D-CTA without DSA.
- 日本脳卒中の外科学会の論文
- 2001-01-31
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