| Objective To investigate the impontance of simulant surgical approach by pre-operative three-dimensional CT angiography (3D-CTA) on approach decision of anterior communicating artery aneurysm in acute stage.Methods A total of38patients of anterior communicating artery aneurysm were admitted into Second Affiliated Hospital of ZheJiang University from January2013to June2013. All patients underwent preoerative CTA, the shape and position of aneurysm were reconstructed according to the operation position of regular transzygomatic pterional approach. Then make the surgical approach decision on the basis of3D-CTA. Finally compare pre-operative simulation by3D-CTA with intra-operative findings as outcomes.Results There are47intracranial aneurysms in38patients by DSA.3D-CTA found44out of47intracranial aneurysms, and the diagnostic positive rate is93.6%. All anterior communicating artery aneurysms in our patients were clipped successfully. With pterion approach in operation,25cases in the left side while13case are right side; Advantage blood flank approach in21cases, the non dominant supply side approach in7cases and10cases of no advantage of blood; in11patients with frontal lobe hematoma,7cases underwent craniotomy by the hematoma side and4cases by the non hematoma side. Our study showed that the orientation of aneurysm neck, as well as relationship between aneurysm and parent artery represented by preoperative3D-CTA were both identical to intraoperative findings and pre-operative DSA. Scoring GOS at discharge,30cases of good recovery,5cases of mild disability, severe disability in2cases,1cases of death.Conclusions Simulant surgical approach by preoperative3D-CTA can precisely reconstruct the three-dimension shape of anterior communicating complex and aneurysm, which provides an important basis for the selection of individual surgical approach. It has good guiding significance for surgical clipping of rupture anterior communicating aneurysm in acute stage. |
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