Determining the Optimal Fluoroscopic View during Aneurysmal Embolization with Rotation DSA

To prevent coil protrusion into the parent artery, the fluoroscopic view during coil packing is quite important. However it is not always easy to find out the optimal fluoroscopic view. We applied a rotation DSA to predict the optimal fluoroscopic view for the endovascular treatment of 4 cases with a cerebral aneurysm. Since the trajectory of the C-arm is restricted within 60 degrees only around the patient's head and the number of DSA shots are limited rather than conventional DSA, we employed three dimensional CT angiography (3D-CT angiography) to focus the range of C-arm rotation. Rotation DSA proved quite useful to determine the optimal fluoroscopic view, when combined with pre-estimation by 3D-CT angiography.

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Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1999.91.3.0424 ◽

1999 ◽

Vol 91 (3) ◽

pp. 424-431 ◽

Cited By ~ 52

Author(s):

Yasuo Murai ◽

Ryo Takagi ◽

Yukio Ikeda ◽

Yasuhiro Yamamoto ◽

Akira Teramoto

Keyword(s):

Intracerebral Hemorrhage ◽

Ct Angiography ◽

Computerized Tomography ◽

Three Dimensional ◽

Ct Scanning ◽

3D Ct ◽

Content Type ◽

Hematoma Enlargement ◽

3D Ct Angiography ◽

Fine Print

Object. The authors confirm the usefulness of extravasation detected on three-dimensional computerized tomography (3D-CT) angiography in the diagnosis of continued hemorrhage and establishment of its cause in patients with acute intracerebral hemorrhage (ICH).Methods. Thirty-one patients with acute ICH in whom noncontrast and 3D-CT angiography had been performed within 12 hours of the onset of hemorrhage and in whom conventional cerebral angiographic studies were obtained during the chronic stage were prospectively studied. Noncontrast CT scanning was repeated within 24 hours of the onset of ICH to evaluate hematoma enlargement.Findings indicating extravasation on 3D-CT angiography, including any abnormal area of high density on helical CT scanning, were observed in five patients; three of these demonstrated hematoma enlargement on follow-up CT studies. Thus, specificity was 60% (three correct predictions among five positives) and sensitivity was 100% (19 correct predictions among 19 negatives). Evidence of extravasation on 3D-CT angiography indicates that there is persistent hemorrhage and correlates with enlargement of the hematoma.Regarding the cause of hemorrhage, five cerebral aneurysms were visualized in four patients, and two diagnoses of moyamoya disease and one of unilateral moyamoya phenomenon were made with the aid of 3D-CT angiography. Emergency surgery was performed without conventional angiography in one patient who had an aneurysm, and it was clipped successfully.Conclusions. Overall, 3D-CT angiography was found to be valuable in the diagnosis of the cause of hemorrhage and in the detection of persistent hemorrhage in patients with acute ICH.

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3D CT Angiography as a Pre-Embolization Study for Embolization of Cerebral Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199970030s230 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 142-148 ◽

Cited By ~ 2

Author(s):

K. Fukasaku ◽

M. Negoro ◽

M. Bundo ◽

N. Kourogi ◽

K. Yamano ◽

...

Keyword(s):

Ct Angiography ◽

Three Dimensional ◽

Cerebral Aneurysms ◽

Parent Artery ◽

3D Images ◽

Image Guide ◽

Laser Lithography ◽

Real Model ◽

Aneurysm Embolization ◽

3D Ct Angiography

An image guide for aneurysm embolization based on three dimensional CT angiography is reported. Multiplanner reformation (MPR) can measure the neck and dome of the aneurysm accurately enough to select the first coils for aneurysms. For neck evaluation, cut model and virtual endoscope are helpful because we can observe the neck from inside of dome or parent artery. Proximal arteries are visualized by 3D images and MPR if needed. Using laser lithography, we can get a real model of aneurysm and parent artery through which we can insert microcatheters and coils. 3D CTA is a dependable modality for embolization of cerebral aneurysms.

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Three-dimensional computerized tomography angiography—guided surgery of acutely ruptured cerebral anuerysms

Journal of Neurosurgery ◽

10.3171/jns.2001.94.5.0718 ◽

2001 ◽

Vol 94 (5) ◽

pp. 718-727 ◽

Cited By ~ 98

Author(s):

Masato Matsumoto ◽

Masanori Sato ◽

Masayuki Nakano ◽

Yuji Endo ◽

Youichi Watanabe ◽

...

Keyword(s):

Ct Angiography ◽

Computerized Tomography ◽

Three Dimensional ◽

Artery Aneurysm ◽

3D Ct ◽

Conventional Angiography ◽

Content Type ◽

Ruptured Aneurysms ◽

3D Ct Angiography ◽

Fine Print

Object. The aim of this study was to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography (3D-CT) angiography alone, without conventional catheter angiography. Methods. In a previous study, 60 patients with subarachnoid hemorrhage (SAH) from ruptured aneurysms were prospectively evaluated using both 3D-CT and conventional angiography, which resulted in a 100% accuracy for 3D-CT angiography in the diagnosis of ruptured aneurysms, and a 96% accuracy in the identification of associated unruptured aneurysms. The results led the authors to consider replacing conventional angiography with 3D-CT angiography for use in diagnosing ruptured aneurysms, and to perform surgery aided by 3D-CT angiography alone without conventional angiography. Based on the results, 100 consecutive patients with SAH who had undergone surgery in the acute stage based on 3D-CT angiography findings have been studied since December 1996. One hundred ruptured aneurysms, including 41 associated unruptured lesions, were detected using 3D-CT angiography. In seven of 100 ruptured aneurysms, which included four dissecting vertebral artery aneurysms, two basilar artery (BA) tip aneurysms, and one BA—superior cerebellar artery aneurysm, 3D-CT angiography was followed by conventional angiography to acquire diagnostic confirmation or information about the vein of Labbé, which was needed to guide the surgical approach for BA tip aneurysms. All of the ruptured aneurysms were confirmed at surgery and treated successfully. Ninety-three patients who underwent operation with the aid of 3D-CT angiography only had no complications related to the lack of information gathered by conventional angiography. The 3D-CT angiography studies provided the authors with the aneurysm location as well as surgically important information on the configuration of its sac and neck, the presence of calcification in the aneurysm wall, and its relationship to the adjacent vessels and bone structures. Conclusions The authors believe that 3D-CT angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.

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Identification of the carotid artery dural ring by using three-dimensional computerized tomography angiography

Journal of Neurosurgery ◽

10.3171/jns.2001.95.3.0533 ◽

2001 ◽

Vol 95 (3) ◽

pp. 533-536 ◽

Cited By ~ 28

Author(s):

Yoshihisa Murayama ◽

Kazuhide Sakurama ◽

Koichi Satoh ◽

Shinji Nagahiro

Keyword(s):

Carotid Artery ◽

Ct Angiography ◽

Computerized Tomography ◽

Three Dimensional ◽

3D Ct ◽

Aneurysm Surgery ◽

Anatomical Studies ◽

Content Type ◽

3D Ct Angiography ◽

Fine Print

✓ The carotid artery (CA) dural ring is an important structure in aneurysm surgery of the paraclinoid region. The authors used three-dimensional computerized tomography (3D-CT) angiography to study the CA dural ring. Three-dimensional computerized tomography angiography was performed in patients with cerebral aneurysms and other cerebrovascular diseases. The paraclinoid segment of the internal carotid artery (ICA) was examined by the shaded surface reconstruction method on targeted 3D-CT angiography. The concavity was recognized in the paraclinoid segment of the ICA. The relationship between the concavity and the dural ring was investigated with anatomical studies and surgical findings. In anatomical studies, the concavity in the paraclinoid segment of the ICA on 3D-CT angiography coincided with the level of attachment of the dural ring. Using 3D-CT angiography, it is possible to identify the location of the dural ring in patients being considered for aneurysm surgery.

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Limitations of three-dimensional reconstructed computerized tomography angiography after clip placement for intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.2005.103.4.0656 ◽

2005 ◽

Vol 103 (4) ◽

pp. 656-661 ◽

Cited By ~ 37

Author(s):

Yoshiko Sagara ◽

Hiro Kiyosue ◽

Yuzo Hori ◽

Michifumi Sainoo ◽

Hirofumi Nagatomi ◽

...

Keyword(s):

Ct Angiography ◽

Computerized Tomography ◽

Intracranial Aneurysms ◽

Three Dimensional ◽

Parent Artery ◽

3D Ct ◽

Metal Artifacts ◽

Content Type ◽

Aneurysm Neck ◽

Fine Print

Object. The authors compared the usefulness of three-dimensional (3D) reconstructed computerized tomography (CT) angiography with 3D digital subtraction (DS) angiography in assessing intracranial aneurysms after clip placement. A retrospective review of clinical cases was performed. Methods. Between May 2001 and May 2003, 17 patients with a total of 20 intracranial aneurysms underwent 3D CT and 3D DS angiography following clip placement. The authors assessed the presence or absence of residual aneurysm necks and stenoocclusive changes in the parent artery and the neighboring artery. The efficacy of CT angiographic visualization was also evaluated. In 12 of the 20 aneurysms, both 3D modalities similarly demonstrated the residual aneurysm neck and stenoocclusive changes in the parent artery and neighboring artery. Three-dimensional CT angiography failed to demonstrate three of the aneurysms, and the studies were not considered suitable for evaluation because of the presence of metallic artifacts. In the remaining five studies, the 3D CT angiograms did not effectively demonstrate the neighboring and parent arteries. The detectability of residual aneurysm necks was correlated with the clip material and with the number of clips applied. Conclusions. Three-dimensional DS angiography is still necessary in cases involving multiple clips or with cobalt alloy clips because the clips appear as metal artifacts on 3D CT angiography.

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