医学文献翻译(中英对照)

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

Kenichi Amagasaki MD, Nobuyasu Takeuchi MD, Takashi Sato MD, Toshiyuki Kakizawa MD, Tsuneo Shimizu MD Kanto Neurosurgical Hospital, Kumagaya, Saitama, Japan

Summary 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.

a 2003 Elsevier Ltd. All rights reserved.

Keywords: 3D-CT angiography, cerebral aneurysm, subarachnoid haemorrhage, surgery

INTRODUCTION

Recently, three-dimensional computed tomography (3D-CT) angiography has become one of the major tools for the identification of cerebral aneurysms because it is faster, less invasive, and more convenient than cerebral angiography.1–7 Patients with ruptured aneurysms could be treated under diagnoses based on only 3D-CT angiography.5;6 3D-CT angiography has some limitations for the preoperative work-up for ruptured cerebral aneurysms, so additional digital subtraction (DS) angiography is still necessary, especially for aneurysms in the posterior circulation.8 Our previous study suggested that 3D-CT

angiography could replace DS angiography in most patients with ruptured cerebral aneurysms in the anterior circulation.1 This study reviewed our experience of treating ruptured cerebral aneurysms in the anterior and posterior circulations based on

3D-CT angiography in 150 consecutive patients to assess the current usage of 3D-CT angiography.

METHODS AND MATERIAL

Patient population

We treated 150 patients, 60 men and 90 women aged from 23 to 80 years (mean 57.5 years), with ruptured cerebral aneurysm identified by 3D-CT angiography between November 1998 and March 2002.

Managementof cases

The presence of nontraumatic subarachnoid haemorrhage (SAH) was confirmed by CT or lumbar puncture findings of xanthochromic cerebrospinal fluid. 3D-CT angiography was performed routinely in all patients. DS angiography was performed in patients with anterior circulation aneurysms only if additional information was considered necessary following a consensus interpretation of the initial CT and 3D-CT angiography by four neurosurgeons. Patients with ruptured aneurysms in the posterior circulation underwent both 3D-CT angiography and DS