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首页> 外文期刊>Neurosurgery >Complementary use of computed tomographic angiography in treatment planning for posterior fossa subarachnoid hemorrhage.
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Complementary use of computed tomographic angiography in treatment planning for posterior fossa subarachnoid hemorrhage.

机译：计算机断层血管造影术在后颅窝蛛网膜下腔出血的治疗计划中的补充使用。

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OBJECTIVE: The goal of this study was to determine whether the complementary use of computed tomographic angiographic (CTA) assessments would provide additional benefits in the evaluation and treatment of ruptured vertebrobasilar artery aneurysms. METHODS: In the past 4.5 years, 35 patients with an infratentorial dominant pattern of subarachnoid hemorrhage were complementarily examined with CTA scanning, after undergoing one or more three-dimensional rotational projection digital subtraction angiographic (DSA) studies. The results of these studies were interpreted by the treating neurosurgeon and an interventional radiologist, to examine the usefulness of the findings for the detection of aneurysms and to determine the grade of parent artery vascular filling and the optical definition of the aneurysm. This information provided additional benefits for case management. RESULTS: Thirty-three aneurysms were detected. For 10 patients, no aneurysm was identified in repeated examinations with the two methods. We detected only 16 of the 25 ruptured aneurysms (64%) on the first DSA scans and, even with repeated examinations, 6 aneurysms were not clearly identified with this technique. CTA scanning revealed the ruptured aneurysms in 25 cases and demonstrated increased vascular filling and improved optical definition of the aneurysms, compared with DSA scanning, in 12 cases (48%). The information obtained from the CTA scans allowed the selection of five patients for endovascular treatment and facilitated the surgical procedures in five cases. CONCLUSION: Complementary CTA examination of the vertebrobasilar complex provides a higher rate of aneurysm detection and improves the optical definition and anatomic projection of these aneurysms, compared with DSA scanning alone. This facilitates therapeutic decision-making (surgical versus endovascular procedures) and allows neurosurgeons to use more restricted surgical exposures.
机译：目的：本研究的目的是确定补充使用计算机断层摄影血管造影（CTA）评估是否可以为评估和治疗椎基底动脉破裂性动脉瘤提供更多益处。方法：在过去的4.5年中，对35例蛛网膜下腔出血的下腹部优势型患者进行了一次或多次三维旋转投影数字减影血管造影（DSA）研究后，通过CTA扫描进行了补充检查。这些研究的结果由治疗神经外科医生和介入放射科医生解释，以检查研究结果对检测动脉瘤的有用性，并确定亲代动脉血管充盈的程度和动脉瘤的光学定义。此信息为案例管理提供了其他好处。结果：发现了33个动脉瘤。对于10例患者，使用两种方法重复检查均未发现动脉瘤。在第一次DSA扫描中，我们仅检测到25个破裂的动脉瘤中的16个（64％），即使进行了反复检查，该技术也无法清楚地识别出6个动脉瘤。与DSA扫描相比，CTA扫描显示25例动脉瘤破裂，并显示血管充盈增加和动脉瘤的光学清晰度改善（12例，占48％）。从CTA扫描中获得的信息允许选择5名患者进行血管内治疗，并在5例患者中简化了手术程序。结论：与单独的DSA扫描相比，对椎基底动脉复合体的补充CTA检查提供了更高的动脉瘤检出率，并改善了这些动脉瘤的光学清晰度和解剖学投影。这有助于做出治疗决策（外科手术与血管内手术），并使神经外科医师可以使用更多受限的外科手术。

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