Surgery of acutely ruptured cerebral aneurysms aided by three-dimensional computerized tomography angiography without conventional angiography

In our previous study, 60 cases of subarachnoid hemorrhage (SAH) from ruptured aneurysms were prospectively evaluated both by three-dimensional computerized tomography angiography (3D-CTA) and conventional catheter angiography (CCA), which resulted in a 100% accuracy for 3D-CTA in the diagnosis of ruptured aneurysms. Based on the results, we assessed whether the aneurysm surgery can be performed on patients with ruptured cerebral aneurysms using 3D-CTA without CCA. 3D-CTA was performed with a helical CT scanner. A total of 123 consequent patients with SAH who had undergone surgery in the acute stage on the basis of 3D-CTA findings were studied. One hundred and twenty-three ruptured aneurysms, including 49 associated unruptured aneurysms, were detected using 3D-CTA. In 7 of 123 ruptured aneurysms, 3D-CTA was followed by CCA to acquire the diagnostic confirmation or the information of the vein. All of the ruptured aneurysms were confirmed at the surgery and treated successfully. One hundred and sixteen patients who underwent the operation with the use of 3D-CTA only had no complications related to the lack of CCA information. 3D-CTA provided us with aneurysm location as well as the surgically important information on the configuration of its sac and neck, and its relationship to adjacent vessels and bone structures. 3D-CTA can replace CCA in the diagnosis of ruptured aneurysms and acute surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CTA without CCA.