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Vol. 14. Issue 3.
Pages 207-215 (January 2003)
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Vol. 14. Issue 3.
Pages 207-215 (January 2003)
Tratamiento quirúrgico de los aneurismas de la arteria comunicante posterior basado en el estudio de angiotac con reconstrucción tridimensional y sin angiografía preoperatoria
Surgical management of posterior communicating artery aneurysms based on computed tomographic angiography with three-dimensional reconstruction and without preoperative angiography
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J.M. González-Darder
, R. Feliu, J.V. Pesudo, J.M. Borrás
Servicios de Neurocirugía, Hospital General de Castellón, Castellón de la Plana
R. Gómez*, C. Díaz*, S. Lázaro*, M. Redondo*, J.H. García-Vila*
* Servicios de Radiodiagnóstico, Hospital General de Castellón, Castellón de la Plana
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Resumen
Objetivos

Estudiar el valor de la exploración mediante angiotomografía computarizada con reconstrucción tridimensional (angio-TC-3D) en el tratamiento microquirúrgico de los aneurismas del territorio de la arteria comunicante posterior (AComP).

Material y Métodos

Se comparan 27 pacientes con aneurismas de la AComP diagnosticados mediante angio-TC-3D y sin angiografía preoperatoria (grupo A) con otros 34 diagnosticados con angiografía cerebral (grupo B). Otros 5 pacientes fueron estudiados con angiografía tras un estudio de angio-TC-3D no concluyente. Se valoran los hallazgos de la angio-TC-3D, angiografía, exploración microquirúrgica y los datos clínicos.

Resultados

Se diagnosticaron un total de 75 aneurismas en los 66 pacientes, además de 3 lesiones adicionales en el postoperatorio en los pacientes del grupo A. La sensibilidad global de la angio-TC-3D es del 91.7% en el diagnóstico de cualquier aneurisma con una especificidad del 100%. La sensibilidad de la angiografía es del 100%, con una especificidad del 94.9%. La mortalidad global fue del 4.5%, sin diferencias entre los grupos con relación a resultados clínicos o complicaciones. En el grupo A el tiempo preoperatorio y la estancia total medias fueron menores que en el grupo B.

Conclusiones

El estudio de los pacientes con hemorragia subaracnoidea mediante angio-TC-3D permite un diagnóstico seguro de los aneurismas de la AComP. También se obtiene información de utilidad a la hora de planificar el abordaje microquirúrgico para la exclusión del aneurisma. Comparado con la angiografía, el diagnóstico de los aneurismas de AComP mediante angio-TC-3D permite mejorar algunos indicadores asistenciales con resultados clínicos semejantes.

Palabras clave:
Hemorragia subaracnoidea
Aneurisma cerebral
Angiografía por tomografía computada
Microcirugía
Summary
Objective

To demonstrate the usefulness of three-dimensional computed tomographic angiography (CT-3D-angiography) in the microsurgical management of aneurysms of the posterior communicating artery (PComA).

Materials and Methods

A series of 27 patients with aneurysms of the PComA diagnosed by means of CT-3D-angiography and without preoperative angiography (group A) were compared with a series of 34 cases diagnosed by cerebral angiography. The findings of the CT-3D-angiography, angiography, microsurgical explo-ration and clinical data were evaluated.

Results

A total of 75 aneurysms were diagnosed preoperatively in 66 patients and 3 additional lesions were found postoperatively in group A. The sensitivity of the CT-3D-angiography was 91.7% for diagnosis of any aneurysm with an specifity of 100%, being the snsi-bility of angiography a 100% and its specifity 94.9%. Mortality rate was 4.5% without differences between groups regarding clinical results or complications. Both the preoperative timing and hospitalization time were shorter in group A.

Conclusion

The study of patients with acute subarachnoid hemorrhage with CT-3D-angiography allows a reliable diagnosis of PComA aneurysms. Moreover, provides usefull information for the microsurgical clipping. When compared with angiography in the diagnosis of PComA aneurysms, CT-3D-angiography allows to improve some health indicators with similar clinical results and complications.

Key words:
Subarachnoid hemorrhage
Cerebral aneurysm
Computed tomography angiography
Microsurgery

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