完整医学文献翻译中英对照.docx

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完整医学文献翻译中英对照

（完整）医学文献翻译（中英对照）

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Currentusageofthree—dimensionalcomputedtomographyangiographyforthediagnosisandtreatmentofrupturedcerebralaneurysms

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—CTangiographymaybelimitedtocomplementaryuseinpatientswithrupturedposteriorcirculationaneurysms。

a2003ElsevierLtd。

Allrightsreserved.

Keywords：

3D-CTangiography,cerebralaneurysm,subarachnoidhaemorrhage,surgery

INTRODUCTION

Recently,three—dimensionalcomputedtomography（3D-CT）angiographyhasbecomeoneofthemajortoolsfortheidentificationofcerebralaneurysmsbecauseitisfaster，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—linecomputerworkstation（VIPstation；TeijinSystemTechnology，Japan）。

Bothvolume—renderedimagesandmaximumintensityprojectionimagesofthecerebralarterieswereconstructed。

Theanteriorcirculationandposteriorcirculationwereevaluatedseparatelyonthevolume-renderedimages,afterageneralsuperiorviewwasobtained。

Theanteriorcirculationwasevaluatedbyfirstobservingtheanteriorcommunicatingartery（ACoA）byrotatingtheview,andtheneachsideofthecarotidsystembyrotatingtheimagewitheditingoutofthecontralateralcarotidartery。

Theposteriorcirculationwasalsoevaluatedbyrotatingtheimagebutwithouteditingoutofanyvessel.Onceapossiblerupturesitewasfound,theviewwaszoomedandcloselyrotatedwiththeothervesselseditedout。

Theaneurysmsizewasmeasuredon3D-CTangiographyasthelargerofthelengthofthedomeorthewidthoftheneck.Manipulationwasperformedbythescannertechnician，withaneurosurgeontoprovideeditingassistance。

DSangiographyacquisition

Standardselectivethree—orfour—vesselDSangiogramswithfrontal，lateral，andobliqueprojectionswereobtained.The3D—CTangiogramwasalwaysavailableasaguideforpossibleadditionalDSangiographyprojections。

AneurysmsizewasmeasuredwithDSangiographywhenthequalityof3D—CTangiographywasinadequate.AllpatientsexceptelderlypatientsorpatientsinsevereconditionunderwentDSangiographypostoperatively。

Gradingofpatients

TheclinicalconditionsofthepatientsatadmissionwereclassifiedaccordingtotheHuntandKosnikgrade.9Clinicaloutcomewasdeterminedat3monthsaccordingtotheGlasgowOutcome

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-posteriorcommunicatingartery（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。

Table3showstheconditiononadmissionandoutcomeat3monthsaftersurgery.S