著者

大岩 美嗣 奥村 浩隆 廣鰭 洋子 田中 亮平 山家 弘雄 照井 慶太 高山 東春

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.41, no.2, pp.130-136, 2013 (Released:2013-07-27)

参考文献数

24

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Recent advancement of three-dimensional computed tomographic angiography (3D-CTA) allows high-spatial-resolution images for the diagnosis of cerebral aneurysms. Prior to operative intervention, the best possible strategy can be developed with the precise knowledge of the shape and location of the lesions in relation to the bone structure and the vascular arrangement, using 3D-CTA. However, replacing conventional digital subtraction angiography (DSA) in order to develop the best treatment strategy remains controversial. In 47 patients with symptomatic cerebral aneurysms, such as subarachnoid hemorrhage or cranial nerve palsy, between April, 2008 and December, 2011, we developed the treatment strategy with computer simulation using only 3D-CTA images of 64- or 320-detector row CT. Thirty-four of the 47 underwent neck clipping of the aneurysms, 3D-CTA clearly showed not only the exact locations of the aneurysms, but also neighboring bone structure such as the anterior clinoid process. Venous arrangements were more clearly shown with 320-detector row CT. In the seven other patients, subsequent DSA was done prior to neck clipping. Coil embolization was employed for the three other patients following the use of 3D-CTA. Two patients underwent parent artery occlusion with EC-IC bypass after DSA. In most cases of the cerebral aneurysms, 3D-CTA seems to be a reliable and less invasive method to develop the operative strategy. The 320-detector row CT can show more precise venous arrangements. If patients have cerebral vasospasm, conventional DSA is still necessary.