Applied values of three-dimensional digital subtraction angiography and CT angiography in individualized keyhole operation of intracranial aneurysms

Abstract

Objective To explore the values of three-dimensional digital subtraction angiography(3D-DSA)and CT angiography(CTA)in keyhole surgery of intracranial aneurysms.Methods A retrospective analysis of 175 patients with 192 intracranial aneurysms,treated by keyhole approaches in our hospital from April 2007 to June 2009,was performed.The imaging features of the aneurysms via 3D-DSA and CTA were analyzed; the designed individualized approaches were performed on these patients:supraorbital keyhole approach in 38 patients(40 aneurysms),pterion keyhole approach in 132 patients(146 aneurysms),inferior-temporal keyhole approach in 2(2 aneurysms)and trans-frontal keyhole longitudinal fissure approach in 3(4 aneurysms).The application and significance of 3D-DSA and CTA in keyhole surgery of intracranial aneurysms were summarized.Results All 175 patients successfully finished the one-time surgery:188 aneurysms were clipped and the other 4 were wrapped.All the aneurysms enjoyed satisfactory clipping under DSA or CTA.According to the modified GOS scores,good result was achieved in 165 patients,mild disability in 6,severe disability in 2,and death in 2.Conclusion 3D-DSA and CTA can clearly show the characteristics of three-dimensional shape about intracranial aneurysms and precisely provide a basis for the design of individual keyhole approach which is prerequisite for a successful surgery. Key words: Intracranial aneurysm; Digital subtraction angiography; CT angiography three-dimensional reconstruction; Keyhole surgery