Usefulness of three-dimensional computed tomographic angiography for surgical planning in treating ruptured intracranial aneurysms

Objective To evaluate the value of 3D-CTA with volume rendering for the planning in early clipping ruptured intracranial aneurysm. Methods Since late 2004 to early 2007, our hospital has adopted a protocol of CTA as the only diagnostic and pretreatment planning study for SAH patients in emergency. Seventy-eight patients finished CTA within 72 hours of initial bleed, and 57 patients were performed aneurysm early clipping. Results During the study period, 125 SAH patients were examined with CTA, including 78 patients finished CTA within 72 hours of initial bleed and there were 61 intracranial aneurysms found in 71 patients, and there were no aneurysms in other 7 patients. Intracranial aneurysm treatment was initiated on the basis of CTA alone. Treatment consisted of early surgical clipping in 57 patients within 72 hours of initial bleed, endovascular coiling in 10 patients. Three patients did not undergo treatment. Because of the neck of aneurysm was unclear in CTA, one patient performed DSA and clipped aneurysm lately. Three-dimensional CT angiography with volume rendering well demonstrated aneurysms and provided useful information including their site, shape, size and the spatial relationship to the surrounding vessels and bony structures. Conclusion Three-dimensional CT angiography with volume rendering is a quick, reliable, and relative noninvasive diagnostic tool for intracranial aneurysms. It can delineate the aneurysmal morphology in detail, and it can provide enough information for making decisions and planning microsurgical clipping in emergency.