nach oben

Neurosurgical Review

Erschienen in:

03.03.2018 | Original Article

Vascular assessment after clipping surgery using four-dimensional CT angiography

verfasst von: Yusuke Kimura, Takeshi Mikami, Kei Miyata, Hime Suzuki, Toru Hirano, Katsuya Komatsu, Nobuhiro Mikuni

Erschienen in: Neurosurgical Review | Ausgabe 1/2019

Einloggen, um Zugang zu erhalten

Abstract

Recent advances in computed tomography angiography (CTA) enable repeated imaging follow up for post-clipping surgery. The purpose of this study was to clarify the critical volume and configuration of the aneurysmal clip in the postoperative evaluation using volume rendering (VR) imaging, and present four-dimensional (4D)-CTA for these larger metal artifacts. A total of 44 patients with cerebral aneurysm, treated using clipping surgery, were included in this study. The metal artifact volume was assessed using CTA and the association between the type of clips and its metal artifact volume was analyzed. A VR image and a 4D-CTA were then produced, and the diagnostic accuracy of arteries around the clip or residual aneurysm on these images was evaluated. In the receiver operating characteristic (ROC) curve analysis, the cutoff value for metal artifacts was 2.32 mm³ as determined through a VR image. Patients were divided into two groups. Group 1 included patients with a simple and small clip, and group 2 included patients with multiple, large or fenestrated clips. The metal artifact volume was significantly larger in group 2, and the group incorporated the cutoff value. Post-clipping status on the VR image was significantly superior in group 1 compared with group 2. In group 2, the imaging quality of post-clipping status on 4D-CTA was superior in 92.9% of patients. The metal artifact volume was dependent on the number, size, or configuration of the clip used. In group 2, evaluation using a 4D-CTA eliminated the effect of the metal artifacts.

Nur mit Berechtigung zugänglich

Brown JH, Lustrin ES, Lev MH, Ogilvy CS, Taveras JM (1999) Reduction of aneurysm clip artifacts on CT angiograms: a technical note. AJNR Am J Neuroradiol 20:694–696PubMed

Brown MA, Parish J, Guandique CF, Payner TD, Horner T, Leipzig T, Rupani KV, Kim R, Bohnstedt BN, Cohen-Gadol AA (2017) A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation. J Neurosurg 126:819–824. https://doi.org/10.3171/2016.2.JNS152059 CrossRefPubMed

Choi JH, Park JE, Kim MJ, Kim BS, Shin YS (2016) Aneurysmal neck clipping as the primary treatment option for both ruptured and unruptured middle cerebral artery aneurysms. J Korean Neurosurg Soc 59:269–275. https://doi.org/10.3340/jkns.2016.59.3.269 CrossRefPubMedPubMedCentral

Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737. https://doi.org/10.1161/STR.0b013e3182587839 CrossRefPubMed

David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S (1999) Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91:396–401. https://doi.org/10.3171/jns.1999.91.3.0396 CrossRefPubMed

Dolati P, Eichberg D, Wong JH, Goyal M (2015) The utility of dual-energy computed tomographic angiography for the evaluation of brain aneurysms after surgical clipping: a prospective study. World neurosurgery 84:1362–1371. https://doi.org/10.1016/j.wneu.2015.06.027 CrossRefPubMed

Fahrendorf DM, Goericke SL, Oezkan N, Breyer T, Hussain S, Sandalcioglu EI, Sure U, Forsting M, Gizewski ER (2011) The value of dual-energy CTA for control of surgically clipped aneurysms. Eur Radiol 21:2193–2201. https://doi.org/10.1007/s00330-011-2147-x CrossRefPubMed

Falk Delgado A, Andersson T, Falk Delgado A (2017) Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic meta-analysis of randomized and non-randomized trials with short- and long-term follow-up. Journal of neurointerventional surgery 9:264–277. https://doi.org/10.1136/neurintsurg-2016-012292 CrossRefPubMed

Fifi JT, Meyers PM, Lavine SD, Cox V, Silverberg L, Mangla S, Pile-Spellman J (2009) Complications of modern diagnostic cerebral angiography in an academic medical center. Journal of vascular and interventional radiology : JVIR 20:442–447. https://doi.org/10.1016/j.jvir.2009.01.012 CrossRefPubMed

10.

Fotakopoulos G, Tsianaka E, Fountas K, Makris D, Spyrou M, Hernesniemi J (2017) Clipping versus coiling in anterior circulation ruptured intracranial aneurysms: a meta-analysis. World neurosurgery 104:482–488. https://doi.org/10.1016/j.wneu.2017.05.040 CrossRefPubMed

11.

Frolich AM, Schrader D, Klotz E, Schramm R, Wasser K, Knauth M, Schramm P (2013) 4D CT angiography more closely defines intracranial thrombus burden than single-phase CT angiography. AJNR Am J Neuroradiol 34:1908–1913. https://doi.org/10.3174/ajnr.A3533 CrossRefPubMed

12.

Gerardin E, Tollard E, Derrey S, Langlois O, Dacher JN, Douvrin F, Freger P, Proust F (2010) Usefulness of multislice computerized tomographic angiography in the postoperative evaluation of patients with clipped aneurysms. Acta Neurochir 152:793–802. https://doi.org/10.1007/s00701-009-0465-4 CrossRefPubMed

13.

Golitz P, Struffert T, Ganslandt O, Lang S, Knossalla F, Doerfler A (2014) Contrast-enhanced angiographic computed tomography for detection of aneurysm remnants after clipping: a comparison with digital subtraction angiography in 112 clipped aneurysms. Neurosurgery 74:606–613; discussion 613-604. https://doi.org/10.1227/neu.0000000000000326 CrossRefPubMed

14.

Golitz P, Struffert T, Ganslandt O, Saake M, Lucking H, Rosch J, Knossalla F, Doerfler A (2012) Optimized angiographic computed tomography with intravenous contrast injection: an alternative to conventional angiography in the follow-up of clipped aneurysms? J Neurosurg 117:29–36. https://doi.org/10.3171/2012.3.jns111895 CrossRefPubMed

15.

Gonner F, Lovblad KO, Heid O, Remonda L, Guzman R, Barth A, Schroth G (2002) Magnetic resonance angiography with ultrashort echo times reduces the artefact of aneurysm clips. Neuroradiology 44:755–758. https://doi.org/10.1007/s00234-002-0825-8 CrossRefPubMed

16.

Grieve JP, Stacey R, Moore E, Kitchen ND, Jager HR (1999) Artefact on MRA following aneurysm clipping: an in vitro study and prospective comparison with conventional angiography. Neuroradiology 41:680–686CrossRefPubMed

17.

Gruber A, Dorfer C, Standhardt H, Bavinzski G, Knosp E (2011) Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery. Neurosurgery 68:657–673; discussion 673. https://doi.org/10.1227/NEU.0b013e31820777ee CrossRefPubMed

18.

Hashimoto A, Mikami T, Komatsu K, Noshiro S, Hirano T, Wanibuchi M, Mikuni N (2017) Assessment of hemodynamic compromise using computed tomography perfusion in combination with 123I-IMP single-photon emission computed tomography without acetazolamide challenge test. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 26:627–635. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.013 CrossRef

19.

Jabbarli R, Pierscianek D, Wrede K, Dammann P, Schlamann M, Forsting M, Muller O, Sure U (2016) Aneurysm remnant after clipping: the risks and consequences. J Neurosurg 125:1249–1255. https://doi.org/10.3171/2015.10.JNS151536 CrossRefPubMed

20.

Kang HS, Han MH, Kwon BJ, Jung SI, Oh CW, Han DH, Chang KH (2004) Postoperative 3D angiography in intracranial aneurysms. AJNR Am J Neuroradiol 25:1463–1469PubMed

21.

Kortman HG, Smit EJ, Oei MT, Manniesing R, Prokop M, Meijer FJ (2015) 4D-CTA in neurovascular disease: a review. AJNR Am J Neuroradiol 36:1026–1033. https://doi.org/10.3174/ajnr.A4162 CrossRefPubMed

22.

Krisht AF, Gomez J, Partington S (2006) Outcome of surgical clipping of unruptured aneurysms as it compares with a 10-year nonclipping survival period. Neurosurgery 58:207–216; discussion 207-216. https://doi.org/10.1227/01.NEU.0000194638.61073.FC CrossRefPubMed

23.

Le Roux PD, Elliott JP, Eskridge JM, Cohen W, Winn HR (1998) Risks and benefits of diagnostic angiography after aneurysm surgery: a retrospective analysis of 597 studies. Neurosurgery 42:1248–1254; discussion 1254-1245

24.

Lee JH, Kim SJ, Cha J, Kim HJ, Lee DH, Choi CG, Lee HK, Suh DC, Ahn JS (2005) Postoperative multidetector computed tomography angiography after aneurysm clipping: comparison with digital subtraction angiography. J Comput Assist Tomogr 29:20–25CrossRefPubMed

25.

Macdonald RL, Wallace MC, Kestle JR (1993) Role of angiography following aneurysm surgery. J Neurosurg 79:826–832. https://doi.org/10.3171/jns.1993.79.6.0826 CrossRefPubMed

26.

Machida H, Tanaka I, Fukui R, Shen Y, Ishikawa T, Tate E, Ueno E (2016) Dual-energy spectral CT: various clinical vascular applications. Radiographics : a review publication of the Radiological Society of North America, Inc 36:1215–1232. https://doi.org/10.1148/rg.2016150185 CrossRef

27.

Mamourian AC, Pluta DJ, Eskey CJ, Merlis AL (2007) Optimizing computed tomography to reduce artifacts from titanium aneurysm clips: an in vitro study. Technical note. J Neurosurg 107:1238–1243. https://doi.org/10.3171/JNS-07/12/1238 CrossRefPubMed

28.

Manninen AL, Isokangas JM, Karttunen A, Siniluoto T, Nieminen MT (2012) A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR Am J Neuroradiol 33:2038–2042. https://doi.org/10.3174/ajnr.A3123 CrossRefPubMed

29.

Murphy M, Bell D, Worth RD, Jehle KS, Critchley GR, Norris JS (2005) Angiography postclipping and coiling of cerebral aneurysms. Br J Neurosurg 19:225–228. https://doi.org/10.1080/02688690500202067 CrossRefPubMed

30.

Nagatani T, Shibuya M, Ooka K, Suzuki Y, Takayasu M, Yoshida J (1998) Titanium aneurysm clips: mechanical characteristics and clinical trial. Neurol Med Chir 38(Suppl):39–44CrossRef

31.

Nakamura Y, Kohmura E (2005) Outcome of surgical clipping for ruptured, low-grade, anterior circulation cerebral aneurysms: should clipping be omitted after International Subarachnoid Aneurysm Trial? Surg Neurol 64:504–509, discussion 509-510. https://doi.org/10.1016/j.surneu.2005.03.040 CrossRefPubMed

32.

Pechlivanis I, Koenen D, Engelhardt M, Scholz M, Koenig M, Heuser L, Harders A, Schmieder K (2008) Computed tomographic angiography in the evaluation of clip placement for intracranial aneurysm. Acta Neurochir 150:669–676. https://doi.org/10.1007/s00701-008-1515-z CrossRefPubMed

33.

Rauzzino MJ, Quinn CM, Fisher WS 3rd (1998) Angiography after aneurysm surgery: indications for “selective” angiography. Surg Neurol 49:32–40 discussion 40-31 CrossRefPubMed

34.

Sagara Y, Kiyosue H, Hori Y, Sainoo M, Nagatomi H, Mori H (2005) Limitations of three-dimensional reconstructed computerized tomography angiography after clip placement for intracranial aneurysms. J Neurosurg 103:656–661. https://doi.org/10.3171/jns.2005.103.4.0656 CrossRefPubMed

35.

Spiotta AM, Hui F, Schuette A, Moskowitz SI (2013) Patterns of aneurysm recurrence after microsurgical clip obliteration. Neurosurgery 72:65–69; discussion 69. https://doi.org/10.1227/NEU.0b013e318276b46b CrossRefPubMed

36.

Thompson BG, Brown RD, Jr., Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Jr., Duckwiler GR, Harris CC, Howard VJ, Johnston SC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J (2015) Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2368–2400. doi:https://doi.org/10.1161/str.0000000000000070

37.

Thornton J, Bashir Q, Aletich VA, Debrun GM, Ausman JI, Charbel FT (2000) What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46:1294–1298; discussion 1298-1300CrossRefPubMed

38.

Uysal E, Ozel A, Erturk SM, Kirdar O, Basak M (2009) Comparison of multislice computed tomography angiography and digital subtraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips. Acta Neurochir 151:131–135. https://doi.org/10.1007/s00701-009-0184-x CrossRefPubMed

39.

van der Schaaf I, van Leeuwen M, Vlassenbroek A, Velthuis B (2006) Minimizing clip artifacts in multi CT angiography of clipped patients. AJNR Am J Neuroradiol 27:60–66PubMed

40.

Willems PW, Taeshineetanakul P, Schenk B, Brouwer PA, Terbrugge KG, Krings T (2012) The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations. Neuroradiology 54:123–131. https://doi.org/10.1007/s00234-011-0864-0 CrossRefPubMed

41.

Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W (2003) Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 227:522–528. https://doi.org/10.1148/radiol.2272012071 CrossRefPubMed

42.

Yu L, Leng S, McCollough CH (2012) Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 199:S9–s15. https://doi.org/10.2214/ajr.12.9121 CrossRefPubMed

43.

Zachenhofer I, Cejna M, Schuster A, Donat M, Roessler K (2010) Image quality and artefact generation post-cerebral aneurysm clipping using a 64-row multislice computer tomography angiography (MSCTA) technology: a retrospective study and review of the literature. Clin Neurol Neurosurg 112:386–391. https://doi.org/10.1016/j.clineuro.2010.02.001 CrossRefPubMed

Titel: Vascular assessment after clipping surgery using four-dimensional CT angiography
verfasst von: Yusuke Kimura
Takeshi Mikami
Kei Miyata
Hime Suzuki
Toru Hirano
Katsuya Komatsu
Nobuhiro Mikuni
Publikationsdatum: 03.03.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Neurosurgical Review / Ausgabe 1/2019
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-018-0962-0

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2019

Hemorrhagic presentation of intracranial pilocytic astrocytomas: literature review

The emerging role of gamma knife radiosurgery in the management of glossopharyngeal neuralgia

Do not omit the grade of malignancy when correlating the lobar location of diffuse gliomas and the risk of preoperative epileptic seizures

Surgery versus stereotactic radiosurgery for the treatment of multiple meningiomas in neurofibromatosis type 2: illustrative case and systematic review

Recurrence of endovascularly and microsurgically treated intracranial aneurysms—review of the putative role of aneurysm wall biology

Endoscopic management of third ventricular colloid cysts in mildly dilated lateral ventricles

Update Chirurgie