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PT  - JOURNAL ARTICLE
AU  - Kaminogo, Makio
AU  - Hayashi, Hideyuki
AU  - Ishimaru, Hideki
AU  - Morikawa, Minoru
AU  - Kitagawa, Naoki
AU  - Matsuo, Yoshitaka
AU  - Hayashi, Kentaro
AU  - Yoshioka, Tsutomu
AU  - Shibata, Shobu
TI  - Depicting Cerebral Veins by Three-Dimensional CT Angiography before Surgical Clipping of Aneurysms
DP  - 2002 Jan 01
TA  - American Journal of Neuroradiology
PG  - 85--91
VI  - 23
IP  - 1
4099  - http://www.ajnr.org/content/23/1/85.short
4100  - http://www.ajnr.org/content/23/1/85.full
SO  - Am. J. Neuroradiol.2002 Jan 01; 23
AB  - BACKGROUND AND PURPOSE: Cerebral veins show wide variation, and unexpected veins occasionally limit surgical procedures for clipping of cerebral aneurysms. This study was undertaken to assess the utility of three-dimensional CT angiography (3D-CTA) in the evaluation of venous anatomy before surgical clipping of cerebral aneurysms.METHODS: 3D-CTA was performed in 19 patients before pterional craniotomy. The venous anatomy visualized by use of 3D-CTA was compared retrospectively with intraoperative findings.RESULTS: 3D-CTA clearly depicted the superficial sylvian veins (SSVs) in 17 of 19 cases. In three of these 17 cases, 3D-CTA failed to reveal the additional connecting veins from SSVs to the midportion of the sphenoid wing. 3D-CTA also depicted bridging veins from: 1) the basal vein of Rosenthal to the sphenoparietal sinus (SPS) (three cases); 2) a junction of the anterior cerebral vein and the deep middle cerebral vein to the SPS (two cases); 3) the anterior cerebral vein into the cavernous sinus (one case); and 4) the deep middle cerebral vein to the cavernous sinus in one case. Surgical findings corresponded well with the angiographic findings. 3D-CTA depicted bridging veins from the frontal base into the SPS in two cases; retraction of the frontal lobe was severely limited in these cases. 3D-CTA also exhibited anatomic variation of deep cerebral veins, which suggests the utility of 3D-CTA in evaluating the risks carried by sacrifice of some bridging veins. In two patients, aneurysmal dissection was restricted because of adhering veins. 3D-CTA depicted these cerebral veins to be lying in contact with the aneurysm. In one case, the contiguous vein was hidden behind a large middle cerebral artery aneurysm; 3D-CTA was helpful for visualization of this vein.CONCLUSION: 3D-CTA can clearly depict the venous anatomy of the brain and is useful for surgical planning of a pterional or temporopolar approach for cerebral aneurysms.