44 patients (between 29 and 77 years old), admitted to Royal Perth Hospital, Weskin state of Australia with suspected symptoms of intracranial aneurysms underwent assessment of using both computed tomographic angiography (CTA) and Digital Subtraction Angiography (DSA). The results: 36 patients had 43 detectable intracranial aneurysm, 26 patients had 1 aneurysm, 5 patients had 2 aneurysms, 1 patient had 3 aneurysms and 8 patients had no detectable aneurysms in both CTA and DSA. CTA was a noninvasive imaging technique with high sensitivity, specificity and accuracy in diagnosis of intracranial aneurysms
Intracranial Aneurysm ; Diagnosis

The authors report their experience with 73 cases of unruptured cerebral aneurysms in a consecutive series of intracranial microsurgery for 380 cerebral aneurysms in 307 patients from September, 1975 through March, 1984. Multiple, symptomatic, and incidental aneurysms are included in this group of 73 unruptured aneurysms. There was no mortality among fifty nine of these cases who had surgery. The only morbidity was due to massive postoperative vasospasm in a patient with multiple aneurysms, that developed on the site of ruptured aneurysm. Discussed in this report are characteristics of three categories of unruptured cerebral aneurysm patients and the principles of the management of unruptured aneurysms. In conclusion, all symptomatic unruptured aneurysms should be clipped immediately upon definite diagnosis, while decision for the operation of multiple unruptured aneurysms and aneurysms detected incidentally should be made with discretion by the surgeon.
Aneurysm ; Aneurysm, Ruptured ; Diagnosis ; Humans ; Intracranial Aneurysm* ; Microsurgery ; Mortality

The introduction of detachable coils in treating cerebral aneurysm patients has revolutionized the management of this disease in the past 15 years. The advancement of imaging resolution and the use of three dimensional imaging not only with catheterized conventional angiography, but also with CTA and MRA have enabled a more thorough evaluation and accurate diagnosis of cerebral aneurysms prior to intervention and has also aided in the treatment process. Therefore, it is essential to organize past studies and create an up to date general diagnostic guideline.
Aneurysm ; Aneurysm, Ruptured* ; Angiography ; Catheters ; Diagnosis ; Humans ; Intracranial Aneurysm

OBJECTIVES: Computed tomographic angiography (CTA) to diagnose intracranial aneurysms in patients with spontaneous subarachnoid hemorrhage (SAH) has been well documented and widely accepted. In this study, it was assessed whether aneurysm surgery can be performed in aneurysm patients by using CTA regardless of their status. METHODS: To assess the clinical value of CTA, we treated patients with SAH using it as the primary means of diagnosis. During the period between August 2001 and May 2003, a consecutive series of 82 cases of ruptured cerebral aneurysms were evaluated via both CTA and postoperative transfemoral cerebral angiography(TFCA), and we investigated the detectability of cerebral aneurysms. In cases of vague CTA findings, we performed TFCA preoperatively. We correlated the CTA results with operative findings and preoperative TFCA, when performed. RESULTS: In 82 patients, 100 aneurysms (96 aneurysms via CTA, 1 aneurysm via TFCA, 3 aneurysms via operation) were disclosed. The size of aneurysms detected by CTA ranged from 1.95 mm to 19.4 mm. Aneurysms that were not found via TFCA were detected by CTA in two patients. Three additional small multiple aneurysms that could not be confirmed via CTA were found through operation. No previously undiscovered aneurysms were found via postoperative TFCA. Corresponding to the operative findings, the sensitivity of CTA was 96%. CONCLUSION: According to our results, we hold that CTA is the first choice among diagnostic methods for the treatment of SAH.
Aneurysm ; Angiography* ; Diagnosis ; Humans ; Intracranial Aneurysm ; Prospective Studies* ; Subarachnoid Hemorrhage

PURPOSE: To evaluate the role of rotational angiography in the diagnosis, characterization, and postoperativeassessment of aneurysm, and in the analysis of arteriovenous malformation(AVM). MATERIALS AND METHODS: Between May1995 and February 1997, 31 patients who had undergone DSA and rotational angiography were retrospectivelyevaluated. Rotational angiographic and lateral DSA images were compared by two radiologists, and in 22 patientswith aneurysmal clipping, location, visibility of the aneurysmal neck, vascular branch anatomy, and projection andshape of the aneurysm were evaluated. The presence or absence of residual aneurysmal neck was evaluated in eightpostoperative patients, and the anatomy of feeder artery and intranidal aneurysm were evaluated in five AVMpatients. RESULT: Twenty-seven aneurysms were found in 22 of 26 patients in whom DSA had indicated thispossibility. Rotational angiography was superior to conventional DSA in the assessment of neck(67%), vascularbranch anatomy(41%), and projection(22%), location(19%), and shape(15%) of the aneurysm. Rotational angiographyhelped confirm the absence of aneurysm at 11 sites, and was also superior to conventional DSA for confirming theabscence of residual neck in four of eight postoperative patients, and to evaluate feeder artery in four of fiveAVM patients. CONCLUSION: Rotational angiography is better than conventional DSA for the evaluation of aneurysmand AVM.
Aneurysm ; Angiography* ; Arteries ; Arteriovenous Malformations* ; Diagnosis ; Humans ; Intracranial Aneurysm* ; Neck

Preoperative evaluation of precise aneurysmal geometry is important for the treatment of intracranial aneurysms. We present two cases of unclippable side wall aneurysms due to their extremely low dome height, which appeared as saccular in the preoperative image because of a comparatively narrow atherosclerotic parent arterial lumen. In both cases, a calcified vessel wall was noted preoperatively. Lack of a definitive neck and abrupt discrepancy between the fragile aneurysmal wall and the atherosclerotic parent arterial wall was confirmed intraoperatively in both cases. This study describes an illustrative mechanism for the finding with emphasis on the importance of its preoperative diagnosis. Intracranial atherosclerosis associated with small side walled aneurysms may lead to overestimation of aneurysm height on preoperative imaging of the intravascular compartment.
Aneurysm* ; Angiography* ; Arteries* ; Atherosclerosis ; Diagnosis ; Humans ; Intracranial Aneurysm ; Intracranial Arteriosclerosis ; Neck ; Parents*

OBJECT: This study was undertaken to assess the reliability of aspect ratio (AR: the maximum dimension of the dome/width of the neck of an aneurysm) in predicting aneurysm rupture. The authors sought to evaluate the utility of these measures for differentiating ruptured and unruptured aneurysms. METHODS: Patients were retrospectively selected for this study based on the availability of angiograms and a clear diagnosis of an unruptured or ruptured aneurysm. 106 patients with 140 aneurysms were included. 19 patients harbored only unruptured lesions, 70 patients only ruptured lesions, and 17 both ruptured and unruptured lesions. The size of the aneurysms and their ARs were determined by examining the angiographic films. Patient's age and sex, and the location of the aneurysm were also recorded. RESULTS: The ruptured aneurysms were larger and had greater ARs. The mean size of unruptured aneurysms was 4.94 mm and that of ruptured ones was 5.53 mm; the corresponding mean ARs were 1.50 and 1.96, respectively. The odds ratio for rupture rose progressively only for the AR. Only 38.3% of ruptured aneurysms had an AR less than 1.80 compared with 74.0% of unruptured lesions. The odds of rupture were 28-fold greater when the AR was larger than 2.07 compared with an AR with an AR less than or equal to 1.30. Only 9.3% of ruptured aneurysms had and AR less than 1.30 compared with 48.1% of unruptured lesions. CONCLUSION: A high AR might reasonably influence the decision to treat actively an unruptured aneurysm independent of its maximum size, so great care should be taken for patients with unruptured intracranial aneurysms with AR of more than 1.80.
Aneurysm* ; Aneurysm, Ruptured ; Diagnosis ; Humans ; Intracranial Aneurysm ; Neck ; Odds Ratio ; Retrospective Studies ; Rupture

OBJECTIVE: Misjudgement of rupture site may result in disastrous postoperative rebleeding from the unclipped but truly ruptured aneurysm. We assess the concordance rate between radiologic findings and operative ones, and then we document the problems in false localization of rupture site in multiple intracranial aneurysms. METHODS: From January 2001 to December 2002, We retrospectively analyzed 14 patients with a total of 32 multiple aneurysms to assess the primary rupture site. The rupture site was determined on the basis of computed tomographic and angiographic findings by neurosurgeons and one neuroradiologist. The operative findings such as healed thrombotic cap, localized clot, and easy collapse before and after clipping of ruptured aneurysms were compared with the predicted radiologic findings. On the other hand, we analyzed the causes in the cases of false localization. RESULTS: The location of ruptured aneurysm was verified at the time of surgery in 10 patients. The concordance rate of localized clot(100%) was higher than laterality of subarachnoid hemorrhage(66.7%) on CT scan, and those of focal vasospasm and nipple formation(100%) were also higher than size(72.7%) or irregularity(83.3%) of aneurysms on angiographic findings. Two of four misjudged patients were expired due to rebleeding from unclipped aneurysms. CONCLUSION: Although most reliable radiologic findings are useful in determination of rupture site, we should also consider less reliable radiologic findings and careful surgical inspection of the target aneurysm. And then early second operation should be performed as soon as possible in cases of misjudgment on initial diagnosis.
Aneurysm ; Aneurysm, Ruptured ; Diagnosis ; Hand ; Humans ; Intracranial Aneurysm* ; Nipples ; Retrospective Studies ; Rupture* ; Tomography, X-Ray Computed

OBJECTIVE: During the last two decades, detection of unruptured intracranial aneurysms has increased because of the improving diagnostic methods, but the management of unruptured intracranial aneurysm is still controversial. We analyzed the angiographic characteristics to compare ruptured aneurysms with unruptured aneurysms. METHODS: The patients were retrospectively selected for this study based on the availability of angiograms and a clear diagnosis of an unruptured or ruptured aneurysm. One hundred sixty nine patients with 209 aneurysms were included in the study. Sixty-one patients harbored only unruptured lesions, 85 only ruptured lesions and 27 had both ruptured and unruptured lesions. RESULTS: The mean age of all the patients was 55.3 years, and it was 53.34 years for those with ruptured aneurysms. It was found that 42.0% of the ruptured aneurysms were on the anterior communicating artery, compared with 10.3% of the unruptured aneurysms. None of the ophthalmic artery aneurysms were ruptured. The mean dome size, depth and aspect ratio of the ruptured aneurysms, except for the neck size, were significantly larger than that of the unruptured aneurysms, but the mean neck size of the ruptured and unruptured aneurysms showed no significant difference. A daughter sac was present in 7.2% of the unruptured aneurysms and in 17.0% of the ruptured aneurysms. CONCLUSION: We suggest that the morphologic features and location of aneurysms should be considered when making decisions regarding whether to treat unruptured aneurysms.
Aneurysm* ; Aneurysm, Ruptured ; Arteries ; Diagnosis ; Humans ; Intracranial Aneurysm ; Neck ; Nuclear Family ; Ophthalmic Artery ; Retrospective Studies ; Rupture*

Cerebral angiography has been essential for the diagnosis of the intracranial aneurysms but, is sometimes accompanied by serious complications. Resolution of CT angiography was up-graded greatly to represent the three-demensional structure of vessels since helical CT had been introduced. We have compred 26 cases of CT angiography and 28 cases of conventional angiography in terms of specificity and sensitivity for the diagnosis, detectable aneurysm diameter, configurational diagnosis and diagnostic confidency. All results showed no statistical difference between CT angiography and conventional angiography. These should suggest that CT angiography could be replaced with conventional angiography for the diagnosis of ruptured aneurysms and even of unruptured aneurysms, resulting in the introduction of first screening modality of unruptured aneurysms.
Aneurysm* ; Aneurysm, Ruptured ; Angiography* ; Cerebral Angiography ; Diagnosis* ; Intracranial Aneurysm ; Mass Screening ; Sensitivity and Specificity ; Tomography, Spiral Computed