Toshiyuki Kakizawa

Treatment of ruptured anterior circulation aneurysm based on computerized tomography angiography: surgical results and indications for additional digital subtraction angiography.

The purpose of this study is to determine whether or to what extent computerized tomography angiography (CTA) can replace digital subtraction angiography (DSA) for ruptured anterior circulation cerebral aneurysms. We reviewed our patients in two different periods and evaluated in what cases we should perform additional DSA. In the first period, both CTA and DSA were routinely performed except on patients that were suitable for emergent surgery with CTA only. In the second period, only CTA was performed routinely as a preoperative workup and if further information was necessary, additional DSA was performed. A total of 106 (52 in the first period and 54 in the second period) patients were included. Characteristics of the patients and outcome at three months were similar in the two periods. In the second period, ten patients underwent additional DSA. Our results suggest that most of cases with ruptured anterior circulation aneurysms can be successfully treated on the basis of CTA alone.

Current usage of three-dimensional computed tomography angiography for the diagnosis and treatment of ruptured cerebral aneurysms

Our previous study suggested that 3D-CT angiography could replace digital subtraction (DS) angiography in most cases of ruptured cerebral aneurysms, especially in the anterior circulation. This study reviewed our further experience. One hundred and fifty patients with ruptured cerebral aneurysms were treated between November 1998 and March 2002. Only 3D-CT angiography was used for the preoperative work-up study in patients with anterior circulation aneurysms, unless the attending neurosurgeons agreed that DS angiography was required. Both 3D-CT angiography and DS angiography were performed in patients with posterior circulation aneurysms, except for recent cases that were possibly treated with 3D-CT angiography alone. One hundred sixteen (84%) of 138 patients with ruptured anterior circulation aneurysms underwent surgical treatment, but additional DS angiography was required in 22 cases (16%). Only two recent patients were treated surgically with 3D-CT angiography alone in 12 patients with posterior circulation aneurysms. Most patients with ruptured anterior circulation aneurysms could be treated successfully after 3D-CT angiography alone. However, additional DS angiography is still necessary in atypical cases. 3D-CT angiography may be limited to complementary use in patients with ruptured posterior circulation aneurysms.