V.A. Moldovanov, E.N. Maslennikova, Kassem Abu Arabi, M.I. Polyak
Rostovsky State Medical University, Rostovsky Regional Medical Diagnostic-and -Treatment Center, Rostov, Russia
Marked achievements in surgical treatment of cerebral aneurysms and a growing practical interest in diagnosis of unruptured aneurysms condition striving for low-invasive and more informative diagnostic technologies.
We want to dwell on our experience of using MR-angiography (MRA) in surgery of cerebral aneurysms. Patients were examined with applying the Gyrosan Intera MR- tomograph (Philips) with a magnetic field induction of 1 T. Standard T1 and T2 SE and FFE images were used for visualization of structural changes. Angiographic study was carried out with the help of volumetric in-flow SD TOF MRA.
There were 52 cases, operated in the Clinic of Neurosurgery of the Rostovsky State Medical University during 2002-2003. MRA was used in all of them; 28 patients were operated only on the basis of MRA data.
Localization of aneurysms was as follows: ICA - 12, anterior communicating-anterior cerebral arteries - 22, MCA - 10, vertebral artery - 3, posterior cerebral artery - 1. There were mirror aneurysms of MCA (2 cases), two homolateral aneurysms of MCA (1 patient) and a combined aneurysm of MCA and PCA (1 patient). All aneurysms were clipped simultaneously.
Six patients were operated during the first 14 days after hemorrhage; 5 of them had a state of the II-III degree of severity (Hunt-Hess scale). Eighteen cases underwent interventions on the 14-30 day since the moment of hemorrhage; a state of 11 of them corresponded to the II-III degree of severity (Hunt-Hess scale); aneurysm rupture in 2 cases of this group resulted in appearance of a big intracerebral hematoma. Interventions were performed more than 30 days later in 20 cases; a state of the II-III degree of severity (Hunt-Hess scale) was watched in 2 of them. Signs of parenchymal hemorrhage and presence blood in liquor spaces were observed in the majority of cases. One patient in a severe state, operated for MCA aneurysm, died of progressive vascular spasm.
There was no MRI-examination in a postoperative period because of applying steel clips. Results of clipping were estimated during opening of aneurysm cupola or on the basis of data of direct control angiography. Aneurysms and a feeder were disconnected in all cases with the exception of one patient. Successful reoperation was performed in 1 female patient with a wide neck of large supraclinoid aneurysm, which became a cause of a clip slide.
The analysis of results demonstrated, that data of MR-angiography allowed to operate 48 out of 52 cases. Direct angiography was used up to the moment of mastering computer modeling of 3D-images (20 cases, representing the first half of this series). Experience accumulation allowed to use it (catheterization panangiography) only in case of unconvincing data of MRI-examination.
Thus, MR-angiography (3D mode) permits to choose surgical tactics and to make effective operations in the majority of cases with arterial aneurysms, which are not complicated by large intracerebral hematomas or marked vascular spasm.