The usefulness of 3D MR angiography in surgery for ruptured cerebral aneurysms

BACKGROUND We have used magnetic resonance angiography (MRA) in screening for unruptur ed cerebral aneurysms since 1993. The development of high-resolution magnet ic resonance (MR) imaging has led to a remarkable improvement in image qual ity. Three-dimensional (3D) MRA can be used for surgical simulation. Here, we report on the usefulness of and problems associated with 3D MRA for the surgery of ruptured cerebral aneurysms. METHODS Between June 1998 and June 2000, 106 patients with SAH diagnosed by 3D MRA underwent surgery. We compared 3D MRA images with operative findings and in vestigated the usefulness of this assessment tool. RESULTS In 48 of 106 cases (45.3%), we were able to perform surgery based on 3D MRA alone. By using the 3D images, we could easily detect the relative locatio n of the aneurysm, its neck and the surrounding arteries. The remaining cas es required further examinations because of uncertainty of diagnosis or ins ufficient information. CONCLUSION 3D MRA is a safe and useful procedure for the diagnosis and surgery of rupt ured cerebral aneurysms. However, in approximately half of all cases, 3D co mputed tomographic angiography (CTA) or digital subtraction angiography (DS A) is required in addition for the planning of surgery. It is important to use 3D MRA for surgery only after taking sufficient consideration of certai n limitations peculiar to MRA. (C) 2001 by Elsevier Science Inc.