We studied the practice of cerebral aneurysm surgery for acute subarachnoid hemorrhage (SAH) based wholly on preoperative computerized tomography angiography (CTA). In an ongoing prospective study, 42 consecutive patients with suspected intracranial aneurysms underwent CTA, digital subtraction angiography (DSA), or both, after an initial plain CT scan. Based on plain CT scans and CTA the decision to proceed to DSA or directly to surgery was made. A total of 42 consecutive patients were studied. In four patients with SAH both the CTA and subsequent DSA were negative for aneurysm. Of 38 patients who underwent CTA before surgery, 16 (42%) also underwent preoperative DSA. The decision to proceed to DSA following CTA was influenced by the location of the aneurysm (anterior and posterior communicating artery aneurysms most commonly proceeded to DSA) but most importantly by the quality of the CTA images. The sensitivity and specificity for aneurysm detection by CTA, as compared to DSA in this group, was 80% and 100%, respectively. The five aneurysms (four in one patient) missed by CTA were all less than 3 mm in size. In 22 patients (58%) aneurysm surgery was based on plain CT and CTA alone. The sensitivity and specificity of CTA in this group, as compared to postoperative DSA, was 89% and 100%, respectively. Three aneurysms were not detected on the preoperative CTA, two of which were juxtasellar internal carotid artery (ICA) aneurysms and the other being a distal pericallosal artery aneurysm (all were < 3 mm in size). Aneurysm surgery based wholly on preoperative plain CT and CTA was possible in over one half of patients in this series thus far; however, small aneurysms (< 3 mm), especially of the juxtasellar ICA are at risk for being undetected by CTA. Nevertheless, the distinct advantage of CTA is its ability to rapidly obtain images which, when clearly demonstrating the ruptured aneurysm, can facilitate safe surgery without the time and dangers associated with DSA.
|Original language||English (US)|
|Journal||Journal of Neurosurgery|
|State||Published - Dec 1 1998|
ASJC Scopus subject areas
- Clinical Neurology