Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004 Nov;14(4):185-93; discussion 193.
doi: 10.1055/s-2004-860946.

Application of CT Angiography of Complex Cerebrovascular Lesions During Surgical Decision Making

Affiliations
Free PMC article

Application of CT Angiography of Complex Cerebrovascular Lesions During Surgical Decision Making

Ying Chen et al. Skull Base. .
Free PMC article

Abstract

Helical computed tomographic angiography (CTA) is a relatively new noninvasive volumetric imaging technique. Since early reports in the 1990s, CTA has rapidly improved image resolution and scan volume. Cerebral arteries can be imaged clearly, which is advantageous in the diagnosis of vascular diseases such as cerebral aneurysms, arteriovenous malformations, and cerebrovascular occlusive disease. Before attacking a cerebrovascular lesion near or in the skull base, precise preoperative knowledge of anatomic relationships between the bony and neurovascular structures is critical for obtaining successful outcomes. The sensitivity of CTA for the detection of cerebral aneurysms < or = 5 mm in diameter may be higher than that of digital subtraction angiography (DSA), with equal specificity and high interoperator reliability. With minor modification to the technique, paraclinoid vascular lesions can be depicted using CTA. We present our experience using CTA in addition to DSA to obtain important anatomic information about skull base vascular lesions that assisted in the clinical decision-making process.

Figures

Figure 1
Figure 1
(A) CTA showing a left ICA aneurysm extending from the region of the clinoid to the level of the ICA bifurcation. (B) Coronal CTA showing aberrant A1 exiting the ophthalmic segment of the ICA. CTA, computed tomographic angiography; ICA, internal carotid artery.
Figure 2
Figure 2
Cerebral angiogram showing the left ICA aneurysm with a relatively wide neck. ICA, internal carotid artery.
Figure 3
Figure 3
(A) Axial CTA showing the aneurysm arising from the distal portion of the basilar artery on the left. (B) Reconstructed coronal projection of the aneurysm with a wide neck. CTA, computed tomographic angiography.
Figure 4
Figure 4
(A) Three-dimensional CTA showing the aneurysm dome projecting superiorly, laterally, and posteriorly above the posterior clinoid process. (B) Three-dimensional CTA superior-inferior view further defines the relationship of the aneurysm fundus to the left posterior cerebral artery. CTA, computed tomographic angiography.
Figure 5
Figure 5
(A) Axial CTA showing a medial projecting clinoidal aneurysm (arrow). (B) Reconstructed 3D maximum intensity pixel projection confirms the suspicion of a small clinoidal aneurysm (arrow). CTA, computed tomographic angiography.
Figure 6
Figure 6
CT without contrast showing a hyperdense lesion along the left medial temporal lobe. CT, computed tomography.
Figure 7
Figure 7
(A) Reconstructed coronal CTA showing the aneurysm arising from the P2-P3 segment of the left posterior cerebral artery with a wide base and dissecting thrombus. (B) Reconstructed 3D maximum intensity pixel projection confirms the presence of the thrombus within the aneurysm (arrow). CTA, computed tomographic angiography.
Figure 8
Figure 8
Coronal MRI showing a tortuous left ICA in the supraclinoid region (arrow). MRI, magnetic resonance image; ICA, internal carotid artery.
Figure 9
Figure 9
Cerebral angiogram showing a left dorsal paraclinoid aneurysm projecting superiorly and medially.
Figure 10
Figure 10
CTA defined the anterior clinoid process in relationship to the neck of the aneurysm, allowing the aneurysm to be clipped without removing the clinoid process. CTA, computed tomographic angiography.

Similar articles

See all similar articles

Cited by 3 articles

Feedback