การประเมินการใช้ภาพ 3 มิติที่สร้างขึ้นด้วยข้อมูลภาพหลอดเลือดสมองจากสถานพยาบาลอื่น สำหรับการผ่าตัดหนีบหลอดเลือดสมองโป่งพอง: แนวทางเพื่อลดการส่งตรวจหลอดเลือดสมองซ้ำที่สถาบันประสาทวิทยา

Yutthana Netwong

Authors

Yutthana Netwong Neurological Institute of Thailand

Keywords:

Cerebral aneurysms, Aneurysm clipping, 3D reconstructions, Angiography, Radiation dose

Abstract

Background: Surgical clipping of cerebral aneurysms at the Neurological Institute of Thailand (NIT) relies on the three-dimensional volume rendering technique (3D VRT) for vascular reconstructions from computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA) to facilitate preoperative planning. Frequently, patients referred from other hospitals have already undergone vascular imaging; however, repeat studies were often required due to the absence of 3D reconstructions or inadequate image quality. Objective: To evaluate the clinical utility of 3D reconstructions generated from cerebral angiographic data provided by referring hospitals, using CT post-processing software (Siemens syngo.via and INSPACE) installed at the department of radiology, Neurological Institute of Thailand, in facilitating aneurysm clipping without the need for repeat angiographic imaging. Methods: This retrospective study included patients who underwent aneurysm clipping at the NIT. Eligible cases had 3D images reconstructed from external imaging data using CT post-processing software. Patients were categorized into two groups: those for whom the reconstructed images were sufficient for surgery, and those who required additional angiographic imaging prior to the surgery. Results: A total of 42 patients were included, consist of 28 men and 14 women, with a mean age of 55 years. Vascular reconstruction images from referring hospitals were available in 41 patients (98%) and no vascular reconstruction was available in 1 patient (2%). After 3D VRT reconstructions, surgical clipping could be performed immediately without additional angiography in 33 patients (79%), while 9 patients (21%) required repeat angiography at NIT before surgery. Conclusion: Reconstruction of a 3D VRT image of a cerebral aneurysm can assist surgeons in performing aneurysm clipping without the need for cerebral angiography at the NIT in 79% of cases. This results in reduced costs, lower radiation dose, and less contrast agent administration for patients.

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