医学文献翻译中英对照.docx

医学文献翻译中英对照.docx

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医学文献翻译中英对照

Currentusageofthree-dimensionalputedtomographyangiographyforthediagnosisandtreatmentofrupturedcerebralaneurysms

KenichiAmagasakiMD,NobuyasuTakeuchiMD,TakashiSatoMD,ToshiyukiKakizawaMD,TsuneoShimizuMDKantoNeurosurgicalHospital,Kumagaya,Saitama,Japan

SummaryOurpreviousstudysuggestedthat3D-CTangiographycouldreplacedigitalsubtraction（DS）angiographyinmostcasesofrupturedcerebralaneurysms,especiallyintheanteriorcirculation.Thisstudyreviewedourfurtherexperience.OnehundredandfiftypatientswithrupturedcerebralaneurysmsweretreatedbetweenNovember1998andMarch2002.Only3D-CTangiographywasusedforthepreoperativework-upstudyinpatientswithanteriorcirculationaneurysms,unlesstheattendingneurosurgeonsagreedthatDSangiographywasrequired.

Both3D-CTangiographyandDSangiographywereperformedinpatientswithposteriorcirculationaneurysms,exceptforrecentcasesthatwerepossiblytreatedwith3D-CTangiographyalone.Onehundredsixteen（84%）of138patientswithrupturedanteriorcirculationaneurysmsunderwentsurgicaltreatment,butadditionalDSangiographywasrequiredin22cases（16%）.Onlytworecentpatientsweretreatedsurgicallywith3D-CTangiographyalonein12patientswithposteriorcirculationaneurysms.Mostpatientswithrupturedanteriorcirculationaneurysmscouldbetreatedsuccessfullyafter3D-CTangiographyalone.However,additionalDSangiographyisstillnecessaryinatypicalcases.3D-CTangiographymaybelimitedtoplementaryuseinpatientswithrupturedposteriorcirculationaneurysms.

a2003ElsevierLtd.Allrightsreserved.

Keywords:

3D-CTangiography,cerebralaneurysm,subarachnoidhaemorrhage,surgery

INTRODUCTION

Recently,three-dimensionalputedtomography（3D-CT）angiographyhasbeeoneofthemajortoolsfortheidentificationofcerebralaneurysmsbecauseitisfaster,lessinvasive,andmoreconvenientthancerebralangiography.1–7Patientswithrupturedaneurysmscouldbetreatedunderdiagnosesbasedononly3D-CTangiography.5;63D-CTangiographyhassomelimitationsforthepreoperativework-upforrupturedcerebralaneurysms,soadditionaldigitalsubtraction（DS）angiographyisstillnecessary,especiallyforaneurysmsintheposteriorcirculation.8Ourpreviousstudysuggestedthat3D-CTangiographycouldreplaceDSangiographyinmostpatientswithrupturedcerebralaneurysmsintheanteriorcirculation.1Thisstudyreviewedourexperienceoftreatingrupturedcerebralaneurysmsintheanteriorandposteriorcirculationsbasedon3D-CTangiographyin150consecutivepatientstoassessthecurrentusageof3D-CTangiography.

METHODSANDMATERIAL

Patientpopulation

Wetreated150patients,60menand90womenagedfrom23to80years（mean57.5years）,withrupturedcerebralaneurysmidentifiedby3D-CTangiographybetweenNovember1998andMarch2002.

Managementofcases

Thepresenceofnontraumaticsubarachnoidhaemorrhage（SAH）wasconfirmedbyCTorlumbarpuncturefindingsofxanthochromiccerebrospinalfluid.3D-CTangiographywasperformedroutinelyinallpatients.DSangiographywasperformedinpatientswithanteriorcirculationaneurysmsonlyifadditionalinformationwasconsiderednecessaryfollowingaconsensusinterpretationoftheinitialCTand3D-CTangiographybyfourneurosurgeons.Patientswithrupturedaneurysmsintheposteriorcirculationunderwentboth3D-CTangiographyandDSangiographyexceptfortworecentpatientswithtypicalvertebralarteryposteriorinferiorcerebellarartery（VA-PICA）aneurysm.

Typicalsaccularaneurysmsweretreatedbyclippingsurgery.

Fusiformanddissectinganeurysmsweretreatedbyproximalocclusionbyeithersurgeryorendovasculartreatmentwithorwithoutbypasssurgery.Regrowthofbleedinganeurysmswastreatedbyeithersurgeryorendovasculartreatment.Postoperatively,allpatientsweremanagedwithaggressivepreventionandtreatmentofvasospasmincludingintra-arterialinfusionofpapaverineortransluminalangioplasty.

3D-CTangiographyacquisitionandpostprocessingCTangiographywasperformedwithaspiralCTscanner（CT-W3000AD;Hitachi,Ibaraki,Japan）.Acquisitionusedastandardtechniquestartingattheforamenmagnum,withinjectionof130mlofnonioniccontrastmaterial（Omnipaque;DaiichiPharmaceutical,Tokyo,Japan）.Thesourceimagesofeachscanweretransferredtoanoff-lineputerworkstation（VIPstation;TeijinSystemTechnology,Japan）.Bothvolume-renderedimagesandmaximumintensityprojectionimagesofthecerebralarterieswereconstructed.Theanteriorcirculationandposteriorcirculationwereevaluatedseparatelyonthevolume-renderedimages,afterageneralsuperiorviewwasobtained.Theanteriorcirculationwasevaluatedbyfirstobservingtheanteriormunicatingartery（ACoA）byrotatingtheview,andtheneachsideofthecarotidsystembyrotatingtheimagewitheditingoutofthecontralateralcarotidartery.Theposteriorcirculationwasalsoevaluatedbyrotatingtheimagebutwithouteditingoutofanyvessel.Onceapossiblerupturesitewasfound,theviewwaszoomedandcloselyrotatedwiththeothervesselseditedout.Theaneurysmsizewasmeasuredon3D-CTangiographyasthelargerofthelengthofthedomeorthewidthoftheneck.Manipulationwasperformedbythescannertechnician,withaneurosurgeontoprovideeditingassistance.

DSangiographyacquisition

Standardselectivethree-orfour-vesselDSangiogramswithfrontal,lateral,andobliqueprojectionswereobtained.The3D-CTangiogramwasalwaysavailableasaguideforpossibleadditionalDSangiographyprojections.AneurysmsizewasmeasuredwithDSangiographywhenthequalityof3D-CTangiographywasinadequate.AllpatientsexceptelderlypatientsorpatientsinsevereconditionunderwentDSangiographypostoperatively.

Gradingofpatients

TheclinicalconditionsofthepatientsatadmissionwereclassifiedaccordingtotheHuntandKosnikgrade.9Clinicaloutewasdeterminedat3monthsaccordingtotheGlasgowOute

Scale.10

RESULTS

TheaneurysmlocationsandsizesareshowninTable1.Onehundredsixteen（84%）of138casesofaneurysmsintheanteriorcirculationweretreatedafteronly3D-CTangiography,and22cases（16%）requiredadditionalDSangiography.Tenof12casesofaneurysmsintheposteriorcirculationrequiredboth3D-CTangiographyandDSangiography,buttworecentcasesoftypicalVA-PICAaneurysmwereclippedafteronly3D-CTangiography（Fig.1）.Thefirst10ofthe22casesintheanteriorcirculation,whichrequiredadditionalDSangiographyweredescribedpreviously,1sothemostrecent12patientsarelistedinTable2.Theserecentcasesincludedsomeatypicalaneurysms.Cases6and8hadafusiformaneurysmoftheinternalcarotidartery（ICA）.AdditionalDSangiographywasperformedtoobtainhaemodynamicinformation.ICAtrappingwithsuperficialtemporalartery-middlecerebralarteryanastomosiswasperformedinCase6becausetheatheroscleroticarteriesfailedtodemonstratetheballoonocclusiontest（Fig.2）.ICAocclusionbyendovasculartreatmentwasperformedinCase8becausethepatientcouldtoleratetheballoonocclusiontest.Cases4,9,and10sufferedregrowthofbleedinganeurysmsafterclippingsurgery.Clipartifactspreventedevaluationoftherupturedsiteaswellasidentificationofdenovoaneurysmsinthesecases（Fig.3）.SurgicalclippingwasperformedinCases4and10andendovasculartreatmentinCase9.Case11hadanACoAaneurysmassociatedwithanarteriovenousmalformation（AVM）（Fig.4）.DSangiographywasperformedtoevaluatetheAVM.Case12hadalargeICA-posteriormunicatingartery（PCoA）aneurysm,andadditionalDSangiographywasperformedbecausethePCoAcouldnotbedetectedby3D-CTangiography（Fig.5）.Cases1,2,3,5,and7presentedwithsmallaneurysms,andDSangiographywasperformedtoexcludeotherlesionsaswellastoobtaininformationabouttheproximalICAforpatientswithsupraclinoidtypeaneurysms.

Table1Distributionandsizeofcerebralaneurysmsin150consecutivepatients

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,ophthalmicartery;ACA,anteriorcerebralartery;MCA,middlecerebralartery;PCA,posteriorcerebralartery;BA,basilarartery;SCA,superiorcerebellarartery.

Table2Twelvepatientswithrupturedanteriorcirculationaneurysmswho

underwentadditionalDSangiography

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-CTangiographyorDSangiography.Table3showstheconditiononadmissionandouteat3monthsaftersurgery.Somepatientswithgoodgradesonadmissiondiedofseverespasm,acutebrainswelling,orpoorgeneralcondition,buttheseouteswerenotrelatedtothepreoperativeradiologicalinformation.

DISCUSSION

ThepresentstudyofrupturedaneurysmsinbothanteriorandposteriorcirculationsfoundthattheindicationsforadditionalDSangiographyintheanteriorcirculationaresimilartothatfoundpreviously,butweexperiencedsomenewatypicalcases.Treatmentoffusiformaneurysmsdependsonthehaemodynamicinformation,whichcouldonlybeobtainedbyDSangiography.ACoAaneurysmassociatedwithAVM,althoughtheinitialCTindicatedthattheaneurysmhadbled,requiredaccurate