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The impact of high-resolution cone-beam CT findings on decision-making for the treatment of unruptured middle cerebral artery aneurysms

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Abstract

Even with the advent of endovascular treatment for intracranial aneurysms, microsurgical clipping continues to play a significant role in the treatment of middle cerebral artery (MCA) aneurysms. Securing perforators around unruptured intracranial aneurysms (UIAs) is essential for minimizing procedural risks in each treatment option. Therefore, we herein investigated whether the findings of high-resolution cone-beam computed tomography (HR-CBCT) have an impact on decision-making for the treatment of MCA UIAs. Patients with MCA UIAs between October 2017 and September 2021 were consecutively recruited for this study. All patients underwent HR-CBCT and 3D-DSA before treatment. The imaging quality of both modalities to visualize the microvasculature around aneurysms was evaluated. Specific findings on the microvasculature surrounding aneurysms on HR-CBCT were investigated to facilitate microsurgical clipping. Fifty-two MCA UIAs were treated, including 43 by microsurgical clipping and 9 by endovascular approaches. The overall imaging quality of HR-CBCT was superior to that of 3D-DSA. Regarding microsurgical insights, sensitivity and specificity for the visualization of small vessels around aneurysms were 79 and 100%, respectively, using HR-CBCT, and 57 and 93%, respectively, using 3D-DSA. The presence of a low-density band between adhesive vessels and aneurysm sacs was indicative of successful and safe microsurgical dissection between these structures. HR-CBCT enabled visualization of the intracranial microvasculature around MCA UIAs at the submillimeter level in vivo. In cases in which the tight adhesion of the microvasculature to the aneurysm sac is indicated by HR-CBCT, an endovascular approach may be considered in order to avoid the risks associated with securing perforators.

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Authors and Affiliations

  1. Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-minami, Asakitaku, Hiroshima, 731 0293, Japan

    Toshinori Matsushige, Yukishige Hashimoto, Michitsura Yoshiyama, Takeshi Hara & Shohei Kobayashi

  2. Department of Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan

    Taichi Ogawa & Gosuke Makimoto

  3. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Shigeyuki Sakamoto

Authors
  1. Toshinori Matsushige
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  2. Yukishige Hashimoto
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  3. Taichi Ogawa
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  4. Gosuke Makimoto
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  5. Michitsura Yoshiyama
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  6. Takeshi Hara
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  7. Shohei Kobayashi
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  8. Shigeyuki Sakamoto
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Contributions

Toshinori Matsushige and Shigeyuki Sakamoto contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Yukishige Hashimoto, Taichi Ogawa, Gosuke Makimoto, Michitsura Yoshiyama, Takeshi Hara, and Shohei Kobayashi. The draft of the manuscript was written by Toshinori Matsushige, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Toshinori Matsushige.

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Ethics approval and consent to participate

The study was approved by the institutional ethical committee (ethics authorization #2018-02-20). All patients consented their data to be used for research according to the information and consent forms.

Human and animal ethics

Research procedures were in accordance with the Helsinki Declaration of the World Medical Association.

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Patients signed informed consent regarding publishing their data and photographs.

Competing interests

The authors declare no competing interests.

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Matsushige, T., Hashimoto, Y., Ogawa, T. et al. The impact of high-resolution cone-beam CT findings on decision-making for the treatment of unruptured middle cerebral artery aneurysms. Neurosurg Rev 46, 26 (2023). https://doi.org/10.1007/s10143-022-01933-x

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  • DOI: https://doi.org/10.1007/s10143-022-01933-x

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