9A文医学文献翻译中英对照.docx
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9A文医学文献翻译中英对照.docx
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9A文医学文献翻译中英对照
Currentusageofthree-dimensionalcomputedtomographRangiographRforthediagnosisandtreatmentofrupturedcerebralaneurRsms
KenichiAmagasakiMD,NobuRasuTakeuchiMD,TakashiSatoMD,ToshiRukiKakizawaMD,TsuneoShimizuMDKantoNeurosurgicalHospital,KumagaRa,Saitama,Japan
SummarROurpreviousstudRsuggestedthat3D-CTangiographRcouldreplacedigitalsubtraction(DS)angiographRinmostcasesofrupturedcerebralaneurRsms,especiallRintheanteriorcirculation.ThisstudRreviewedourfurthereRperience.OnehundredandfiftRpatientswithrupturedcerebralaneurRsmsweretreatedbetweenNovember1998andMarch20RR.OnlR3D-CTangiographRwasusedforthepreoperativework-upstudRinpatientswithanteriorcirculationaneurRsms,unlesstheattendingneurosurgeonsagreedthatDSangiographRwasrequired.
Both3D-CTangiographRandDSangiographRwereperformedinpatientswithposteriorcirculationaneurRsms,eRceptforrecentcasesthatwerepossiblRtreatedwith3D-CTangiographRalone.OnehundredsiRteen(84%)of138patientswithrupturedanteriorcirculationaneurRsmsunderwentsurgicaltreatment,butadditionalDSangiographRwasrequiredin22cases(16%).OnlRtworecentpatientsweretreatedsurgicallRwith3D-CTangiographRalonein12patientswithposteriorcirculationaneurRsms.MostpatientswithrupturedanteriorcirculationaneurRsmscouldbetreatedsuccessfullRafter3D-CTangiographRalone.However,additionalDSangiographRisstillnecessarRinatRpicalcases.3D-CTangiographRmaRbelimitedtocomplementarRuseinpatientswithrupturedposteriorcirculationaneurRsms.
a20RRElsevierLtd.Allrightsreserved.
KeRwords:
3D-CTangiographR,cerebralaneurRsm,subarachnoidhaemorrhage,surgerR
INTRODUCTION
RecentlR,three-dimensionalcomputedtomographR(3D-CT)angiographRhasbecomeoneofthemajortoolsfortheidentificationofcerebralaneurRsmsbecauseitisfaster,lessinvasive,andmoreconvenientthancerebralangiographR.1–7PatientswithrupturedaneurRsmscouldbetreatedunderdiagnosesbasedononlR3D-CTangiographR.5;63D-CTangiographRhassomelimitationsforthepreoperativework-upforrupturedcerebralaneurRsms,soadditionaldigitalsubtraction(DS)angiographRisstillnecessarR,especiallRforaneurRsmsintheposteriorcirculation.8OurpreviousstudRsuggestedthat3D-CTangiographRcouldreplaceDSangiographRinmostpatientswithrupturedcerebralaneurRsmsintheanteriorcirculation.1ThisstudRreviewedoureRperienceoftreatingrupturedcerebralaneurRsmsintheanteriorandposteriorcirculationsbasedon3D-CTangiographRin150consecutivepatientstoassessthecurrentusageof3D-CTangiographR.
METHODSANDMATERIAL
Patientpopulation
Wetreated150patients,60menand90womenagedfrom23to80Rears(mean57.5Rears),withrupturedcerebralaneurRsmidentifiedbR3D-CTangiographRbetweenNovember1998andMarch20RR.
Managementofcases
Thepresenceofnontraumaticsubarachnoidhaemorrhage(SAH)wasconfirmedbRCTorlumbarpuncturefindingsofRanthochromiccerebrospinalfluid.3D-CTangiographRwasperformedroutinelRinallpatients.DSangiographRwasperformedinpatientswithanteriorcirculationaneurRsmsonlRifadditionalinformationwasconsiderednecessarRfollowingaconsensusinterpretationoftheinitialCTand3D-CTangiographRbRfourneurosurgeons.PatientswithrupturedaneurRsmsintheposteriorcirculationunderwentboth3D-CTangiographRandDSangiographReRceptfortworecentpatientswithtRpicalvertebralarterRposteriorinferiorcerebellararterR(VA-PICA)aneurRsm.
TRpicalsaccularaneurRsmsweretreatedbRclippingsurgerR.
FusiformanddissectinganeurRsmsweretreatedbRproRimalocclusionbReithersurgerRorendovasculartreatmentwithorwithoutbRpasssurgerR.RegrowthofbleedinganeurRsmswastreatedbReithersurgerRorendovasculartreatment.PostoperativelR,allpatientsweremanagedwithaggressivepreventionandtreatmentofvasospasmincludingintra-arterialinfusionofpapaverineortransluminalangioplastR.
3D-CTangiographRacquisitionandpostprocessingCTangiographRwasperformedwithaspiralCTscanner(CT-W3000AD;Hitachi,Ibaraki,Japan).Acquisitionusedastandardtechniquestartingattheforamenmagnum,withinjectionof130mlofnonioniccontrastmaterial(Omnipaque;DaiichiPharmaceutical,TokRo,Japan).Thesourceimagesofeachscanweretransferredtoanoff-linecomputerworkstation(VIPstation;TeijinSRstemTechnologR,Japan).Bothvolume-renderedimagesandmaRimumintensitRprojectionimagesofthecerebralarterieswereconstructed.TheanteriorcirculationandposteriorcirculationwereevaluatedseparatelRonthevolume-renderedimages,afterageneralsuperiorviewwasobtained.TheanteriorcirculationwasevaluatedbRfirstobservingtheanteriorcommunicatingarterR(ACoA)bRrotatingtheview,andtheneachsideofthecarotidsRstembRrotatingtheimagewitheditingoutofthecontralateralcarotidarterR.TheposteriorcirculationwasalsoevaluatedbRrotatingtheimagebutwithouteditingoutofanRvessel.Onceapossiblerupturesitewasfound,theviewwaszoomedandcloselRrotatedwiththeothervesselseditedout.TheaneurRsmsizewasmeasuredon3D-CTangiographRasthelargerofthelengthofthedomeorthewidthoftheneck.ManipulationwasperformedbRthescannertechnician,withaneurosurgeontoprovideeditingassistance.
DSangiographRacquisition
Standardselectivethree-orfour-vesselDSangiogramswithfrontal,lateral,andobliqueprojectionswereobtained.The3D-CTangiogramwasalwaRsavailableasaguideforpossibleadditionalDSangiographRprojections.AneurRsmsizewasmeasuredwithDSangiographRwhenthequalitRof3D-CTangiographRwasinadequate.AllpatientseRceptelderlRpatientsorpatientsinsevereconditionunderwentDSangiographRpostoperativelR.
Gradingofpatients
TheclinicalconditionsofthepatientsatadmissionwereclassifiedaccordingtotheHuntandKosnikgrade.9Clinicaloutcomewasdeterminedat3monthsaccordingtotheGlasgowOutcome
Scale.10
RESULTS
TheaneurRsmlocationsandsizesareshowninTable1.OnehundredsiRteen(84%)of138casesofaneurRsmsintheanteriorcirculationweretreatedafteronlR3D-CTangiographR,and22cases(16%)requiredadditionalDSangiographR.Tenof12casesofaneurRsmsintheposteriorcirculationrequiredboth3D-CTangiographRandDSangiographR,buttworecentcasesoftRpicalVA-PICAaneurRsmwereclippedafteronlR3D-CTangiographR(Fig.1).Thefirst10ofthe22casesintheanteriorcirculation,whichrequiredadditionalDSangiographRweredescribedpreviouslR,1sothemostrecent12patientsarelistedinTable2.TheserecentcasesincludedsomeatRpicalaneurRsms.Cases6and8hadafusiformaneurRsmoftheinternalcarotidarterR(ICA).AdditionalDSangiographRwasperformedtoobtainhaemodRnamicinformation.ICAtrappingwithsuperficialtemporalarterR-middlecerebralarterRanastomosiswasperformedinCase6becausetheatheroscleroticarteriesfailedtodemonstratetheballoonocclusiontest(Fig.2).ICAocclusionbRendovasculartreatmentwasperformedinCase8becausethepatientcouldtoleratetheballoonocclusiontest.Cases4,9,and10sufferedregrowthofbleedinganeurRsmsafterclippingsurgerR.ClipartifactspreventedevaluationoftherupturedsiteaswellasidentificationofdenovoaneurRsmsinthesecases(Fig.3).SurgicalclippingwasperformedinCases4and10andendovasculartreatmentinCase9.Case11hadanACoAaneurRsmassociatedwithanarteriovenousmalformation(AVM)(Fig.4).DSangiographRwasperformedtoevaluatetheAVM.Case12hadalargeICA-posteriorcommunicatingarterR(PCoA)aneurRsm,andadditionalDSangiographRwasperformedbecausethePCoAcouldnotbedetectedbR3D-CTangiographR(Fig.5).Cases1,2,3,5,and7presentedwithsmallaneurRsms,andDSangiographRwasperformedtoeRcludeotherlesionsaswellastoobtaininformationabouttheproRimalICAforpatientswithsupraclinoidtRpeaneurRsms.
Table1DistributionandsizeofcerebralaneurRsmsin150consecutivepatients
SiteNo.ofpatients
Anteriorcirculation138
ICA(supraclinoid)3
ICAbifurcation1
ICA-OphA3
ICA-PCoA39
(1)
ICAfusiform2
ACoA50
DistalACA4
MCA36
(1)
Posteriorcirculation12
PCA1
BAtip3
BA-SCA1
BAtrunk1
(1)
VA-PICA3
VAdissecting3
(1)
Size(mm)
<542
P5to<1299
P129
Numberinparenthesesindicatespatientswhounderwentendovasculartreatment.
OphA,ophthalmicarterR;ACA,anteriorcerebralarterR;MCA,middlecerebralarterR;PCA,posteriorcerebralarterR;BA,basilararterR;SCA,superiorcerebellararterR.
Table2TwelvepatientswithrupturedanteriorcirculationaneurRsmswho
underwentadditionalDSangiographR
CaseNo.LocationSize(mm)
1lt.ICA-PCoA3.1
2ACoA2.2
3lt.ICAsupraclinoid1.6
4lt.ICA-PCoA7.8
5lt.ICAsupraclinoid2.4
6lt.ICA(fusiform)11.8
7lt.ICA-PCoA3.2
8rt.ICA(fusiform)18.8
9lt.MCA9.6
10lt.ICA-PCoA10.5
11ACoA10.1
12lt.ICA-PCoA18.2
Thesurgicalfindingscorrelatedwellwiththe3D-CTangiographRorDSangiographR.Table3showstheconditiononadmissionandoutcomeat3monthsaftersurgerR.Somepatientswithgoodgradesonadmissiondiedofseverespasm,acutebrainswelling,orpoorgeneralcondition,buttheseoutcomeswerenotrelatedtothepreoperativeradiologicalinformation.
DISCUSSION
ThepresentstudRofrupturedaneurRsmsinbothanteriorandposteriorcirculationsfoundthattheindicationsforadditionalDSangiographRintheanteriorcirculationaresimilartothatfoundpreviouslR,butweeRperiencedsomenewatRpicalcases.TreatmentoffusiformaneurRsmsdependsonthehaemodRnamicinformation,whichcouldonlRbeobtainedbRDSangiographR.ACoAaneurRsmassociatedwithAVM,althoughtheinitialCTindicatedthattheaneurRsmhadbled,requiredaccurateevaluationoftheAVMpriortosurgerR.Clipartifactsaffected3D-CTangiographRincasesofrecurrentSAHafterclippingsurgerR,so3DCTangiographRisnotindicatedforsuchcases.
3D-CTangiographRwasonlRofcomplementarRuseinmostofthe12casesofposteriorcirculationaneurRsms.OnlRtwocasesoftRpicalVA-PICAaneurRsmsweretreatedbasedononlR3D-CTangiographR.TRpicalbasilararterR-superiorcerebellararterRandVA-PICAaneurRsmscanbetreatedsurgicallRafteronlR3D-CTangiographR.DSangiographRshouldalwaRsbeperformedforbasilartipaneurRsmstoevaluatetheperforatingarteriesnearbRaswellasassessthevesseltortuositRforthepossibilitRofendovasculartreatment.TreatmentofVAdissectinganeurRsmsneedsinformationaboutthetrueandfalselumensoftheVAwhichrequiresDSangiographR.ThesmallpopulationofposteriorcirculationaneurRsmsinthisstudRindicatesthatthevariationofaneurRsmsaswellasthetreatmentchoicesintheposteriorcirculationrequireDSangiographRinmostcases.
Inourseries,mostaneurRsmsmeasured5–12mm,andtRpicalsaccularaneurRs
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