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Journal of Neurosurgical Sciences 2002 March;46(1):4-9

lingua: Inglese

Use of spi­ral com­pu­ter­ized tomog­ra­phy angio­gra­phy in ­patients ­with cere­bral aneu­rysm. Our expe­ri­ence

Caruso R. 1, Colonnese C. 2, Elefante A. 2, Innocenzi G. 1, Raguso M. 1, Gagliardi F. M. 1

1 Department of Neurosurgery, ­IRCCS Neuromed, Molise;
2 Department of Neuroradiology, ­IRCCS Neuromed, Molise


Background. The pur­pose is to high­light the use­ful­ness of CT angio­gra­phy (CTA) in the diag­no­sis and sur­gi­cal treat­ment of cere­bral aneu­rysms.
Methods. Thirty-one ­patients ­with sub­arach­noid hae­mor­rhag­es ­were sub­ject­ed to CT angio­gra­phy and in ­those cas­es ­where ­this ­test did not ­reveal the aneu­rysm or did not sup­ply suf­fi­cient infor­ma­tion relat­ing to it, sub­se­quent­ly a dig­i­tal sub­trac­tion angio­gra­phy was ­also per­formed. Each aneu­rysm-pos­i­tive CTA was re-pro­cessed ­using the ­3-D tech­niques, ­with the neu­ro-radiol­o­gist and the neu­ro-sur­geon work­ing in ­close co-oper­a­tion.
Results. In 27 cas­es the CTA diag­nosed an aneu­rysm, and in the 4 cas­es ­where no vas­cu­lar mal­for­ma­tions ­were ­revealed, ­also the tra­di­tion­al angio­gra­phy did not ­show any pathol­o­gy.
In 17 out of 18 cas­es oper­at­ed on in ­order to ­clip the aneu­rysm, the CTA sup­plied all the infor­ma­tion need­ed for the sur­gery and it was pos­si­bile to recon­struct imag­es sim­i­lar to ­those of the sur­gi­cal ­field. This led to improve­ment in the pro­gram­ming of the sur­gi­cal inter­ven­tion; in 1 ­case ­only was it ­also nec­es­sary to per­form the DSA ­before the oper­a­tion.
Conclusions. CT angio­gra­phy, ­because it is non-inva­sive, ­easy to per­form, diag­nos­ti­cal­ly reli­able, and ­because the 3-D re-con­struc­tions ­offer the ­chance to ­create imag­es of the pos­sible oper­at­ing ­field, is the ­first-­choice ­test to be adopt­ed in the treat­ment of sub­arach­noid hae­mor­rhag­es, ­even ­though in ­some cas­es the use of the tra­di­tion­al angio­gra­phy is ­still nec­es­sary and ­should be car­ried out when­ev­er the CTA ­does not ­reveal vas­cu­lar mal­for­ma­tions.

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