Three-Dimensional Computed tomographic angiography as a substitue for IA-DSA in the diagnosis and surgical planning of intracranial aneurysm

초록

Objective: To investigate the possibility of 3D-CTA as a substitute for IA-DSA in the diagnosis and surgical planning of intracranial aneurysm. Methods: All patients suspected to have intracranial aneurysms underwent 3D-CTA first and we decided to proceed to IA-DSA or directly to surgery. IF 3D-CTA failed to reveal aneurysms, IA-DSA was performed for further evaluation. All patients who survied to 7th postoperative day underwent postoperative IA-DSA. We determined sensitivity and specificity of 3D-CTA on the basis of surgical or IA-DSA findings and evaluate reasons for performing preoperative IA-DSA and angiographic outcome of surgeries with 3D-CTA soley. Results: Sensitivity of 3D-CTA was 96.2% and specificity was 71.4%. Sixty-three of 83 surgeries(75.9%) were performed on the base of 3D-CTA alone and successful clipping was possible in 60 cases. Remaining 20 cases needed preoperative IA-DSA for identifications of surrounding branches, venous evaluation for selecting approach, complete visualization of aneurysm archtecture, investigating associated vascular anomaly, or preoperative evaluation of vasospasm. Conclusion: 3D-CTA can replace IA-DSA in the diagnosis and surgical planning in a substantial portion of aneurysm and it can be used practically as aprimary management tool for intracranial aneurysm.