Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography

Objective. To study the posibilities of the microsurgical management of rup tured intracranial aneurysms with the sole preoperative information provide d by computed tomography angiography with three-dimensional reconstruction 3D-CTA). Methods. Patients were studied with 3D-CTA after diagnosis of subarachnoid hemorrhage. If the study had an adequate quality and revealed an aneurysm c ongruent with the clinical findings or neurological examination and/or with the location of the bleeding on computed tomography (CT) scan an early mic rosurgical clipping of the lesion was done. When the quality of the 3D-CTA study was not adequate or the quality being adequate displayed no lesions o r the findings were not accurate enough to warrant direct microsurgical tre atment, the patient was studied with cerebral digital substraction (DS) ang iography. A total of 44 consecutive patients harbouring a total of 47 intra cranial aneurysms diagnosed by 3D-CTA and without preoperative DS angiograp hy were submitted to microsurgical clipping and included in the study. Results. The overall mortality was 15.9% and the favourable results evaluat ed 6 months after discharge by means of the Glasgow Outcome Scale reached 7 0.4%. All lesions were successfully clipped. Surgery was done a mean of 4.1 days after the admission bleeding. A total of four microlesions undiagnose d by 3D-CTA were found at surgery and clipped. Postoperative DS angiography and necropsy findings were also used as control of the 3D-CTA findings but no additional information was provided excepting the finding in DS angiogr aphy of an asymptomatic intracavernous aneurysm. Therefore the sensitivity of the 3D-CTA for diagnosis of symtomatic aneurysms was 100% and the overal l sensitivity 90.4%, Conclusions. We have reached similar results in patients operated on with o r without preoperative angiography. 3D-CTA provides very valuable anatomica l information, which has an additional value in the microsurgical treatment of aneurysms of the anterior communicating artery complex. Finally, select ed cases of ruptured intracranial aneurysms can be successfully managed wit h the preoperative information provided by 3D-CTA and without DS angiograph y.