title: Usefulness of preoperative three-dimensional computed tomographic angiography with two-dimensional computed tomographic imaging for rupture point detection of middle cerebral artery aneurysms.
abstract: OBJECTIVE
  We report the technique of three-dimensional computed tomographic (CT) angiography with a two-dimensional CT image aiding in the early operation of ruptured middle cerebral artery aneurysms. This combined image allows the prediction of the rupture point in the aneurysm and may reduce the risk of rupture during early clipping surgery.
  
  
  METHODS
  The findings for 14 patients with 14 middle cerebral artery ruptured aneurysms who underwent subsequent early clipping were analyzed. The average aneurysm size was 8.5 mm, and there were two large and one giant aneurysms. CT examinations were performed by means of a multidetector CT scanner (Aquilion M16; Toshiba Medical Systems, Tokyo, Japan) and reconstructed with a workstation (ZIO M900 QUADRA; Amin Co., Ltd., Tokyo, Japan). We constructed an operating view through three-dimensional CT angiography for a lateral transsylvian approach with a two-dimensional CT image (nonshaded volume-rendering image), which was perpendicular to the direction of the surgical approach. Using this combined image, we predicted the rupture point of the aneurysm and successfully performed clipping surgery through a lateral transsylvian approach. Rupture points were confirmed at the time of surgery. Rupture points of 13 out of 14 aneurysms appeared as we expected, but one differed; all aneurysms were successfully clipped. Thirteen of the 14 patients could be clipped without rupture at surgery, but the remaining patient experienced rupture just after craniotomy.
  
  
  CONCLUSIONS
  The combination of three-dimensional CT angiography and two-dimensional CT images may help improve the surgical outcome by indicating aneurysmal rupture points, leading to the prevention of rupture.
authors.affiliation: Department of Neurosurgery, Japan Defense Force Central Hospital, Tokyo, Japan. mswokada@mishuku.gr.jp
authors.forename: Kojiro
authors.initials: K
authors.lastname: Wada
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Arimoto
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ohkawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Shirotani
authors.forename: Yohsitaro
authors.initials: Y
authors.lastname: Matsushita
authors.forename: Takashi
authors.initials: T
authors.lastname: Takahara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012421:Rupture; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome