CT evaluation of late cerebral infarction after operation for ruptured cerebral aneurysm
The cause of cerebral vasospasm after aneurysmal SAH is multifactorial and remains still unresolved. We clarified delayed low density areas (LDA) on CT after aneurysmal SAH surgery and analyzed different patterns of delayed LDA on CT.
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CT evaluation of late cerebral infarction after operation for ruptured cerebral aneurysm H. Wanifuchi, A. Sasahara, S. Sato Department of Neurosurgery, Saitamaken Saiseikai Kurihashi Hospital, Saitama, Japan
Summary Background. The cause of cerebral vasospasm after aneurysmal SAH is multifactorial and remains still unresolved. We clarified delayed low density areas (LDA) on CT after aneurysmal SAH surgery and analyzed different patterns of delayed LDA on CT. Method. We studied 177 out of 251 consecutive patients with aneurysmal SAH and analyzed different patterns of late LDA after surgery on CT. Findings. Late LDAs were demonstrated in 28 patients (28=177 ¼ 15.8%). The types of late LDAs on CT after SAH were divided into five patterns. Single lesions (18=28 ¼ 64.3%) were significantly frequently observed: single cortical, 11=28 ¼ 39.3%; single deep, 7=28 ¼ 25.0.%; multiple cortical, 4=28 ¼ 14.3%; multiple deep, 2=28 ¼ 7.1%; and multiple combined (cortical þ deep), 4=28 ¼ 14.3%. According to Fisher’s CT classification, group 2 was observed in 6 patients (6=28 ¼ 21.4%) and group 3 in 22 (22=28 ¼ 78.6%). Conclusions. Delayed LDA on CT images, suggesting late vasospasm, showed various patterns of cerebral infarction. Therefore, there may be several pathways for the development of vasospasm. Keywords: Subarachnoid haemorrhage; ruptured cerebral aneurysm; vasospasm; cerebral infarction.
Introduction We clarified the pattern of cerebral infarction after operation for ruptured cerebral aneurysm by CT, and evaluated the pathological condition of late cerebrovascular spasm.
Methods and materials Of 251 consecutive patients with subarachnoid haemorrhage (SAH) due to ruptured cerebral aneurysm who underwent treatment between
Correspondence: Hiroshi Wanifuchi, M.D., Department of Neurosurgery, Saitamaken Saiseikai Kurihashi Hospital, 714-6 Kouemon, Kurihashi-cho, Kitakatsushika-gun, Saitama 349-1105, Japan. e-mail: [email protected]
October 1997 and July 2005, 177 were included in this study. Excluded were the patients showing a low density area early after operation, a definite perforating artery infarction, or a low density area around the clip. Also excluded were the patients after the removal of haematoma as a complication and those showing a low density area around the hematoma. In addition, SAH(þ) Ope() patients were also excluded because more than 50% of them showed H&K grade V, which was difficult to differentiate from LDA due to brain herniation, and only a few survived until 2 weeks after the onset of SAH.
Results Concerning the surgical technique, clipping was performed in 144 of 177 patients, coiling in 25, trapping in 6, coating in 1, and proximal occlusion in 1. LDA on CT images excluding the above exclusion criteria was observed in 28 (28=177 ¼ 15.8%). The LDA pattern on CT images was evaluated by the method of Rabinstein et al. [2] (Fig. 1). Single lesions (64.3%) were significantly frequently observed: single cortical, 11=28 ¼ 39.3%; single deep, 7=28 ¼ 25.0%; multiple cortical, 4=28 ¼ 14.3%; multiple
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