脑动脉瘤:在有限的临床环境和新机器人时代,是否应该重新审视其检测和筛选策略?

P. Ambrosi, C. Ambrosi
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引用次数: 0

摘要

尽管任务艰巨,但合理的脑动脉瘤可视化可以通过无创方法进行,如磁共振血管造影(识别3 - 5mm大小的小动脉瘤),当进行体积渲染和3D飞行时间等特殊序列时,灵敏度高达95%,准确度高,或CT血管造影对大于3mm的动脉瘤具有良好的灵敏度[5]。这使得DSA不再被认为是建立脑动脉瘤诊断的必要条件[1]。非侵入性方法尤其适用于筛查高危脑动脉瘤人群,例如患有遗传性或胶原蛋白疾病的患者,熟悉发生或有多处动脉瘤病史的患者,或“轻微”神经系统症状,如慢性或近期头痛或偏头痛,如头痛、视力丧失、颅神经病变、锥体束功能障碍、垂体临床表现、非典型面部疼痛等。在蛛网膜下腔出血或脑动脉瘤治疗后的随访中,也特别应用血管oct作为常规检查[7-15]。
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Brain Aneuryms: Isn’t Time to Review the Strategy for its Detection and Screening in Limited Clinical Environment and in the New Robotic Era?
Submit Manuscript | http://medcraveonline.com Despite challenging task, a reasonable brain aneurysm visualization can be performed by noninvasive methods as magnetic resonance angiography (which identifies small aneurysms between 3 to 5 mm size) with up to 95% sensitivity and high accuracy when special sequences as volume rendering and 3D time-of-flight are performed or CT angiography which has good sensitivity for aneurysms larger than 3 mm [5]. This is making the DSA is no longer considered essential for establishing the diagnostic of brain aneurysms [1]. Non-invasive methods are particularly recognised for screening of the highrisk brain aneurysmal populations e.g patients with genetic or collagen diseases, familiar occurrence or with history of multiple aneurysms or “minor” neurological symptoms including e.g chronic or recent headache or migraines like headache, visual acuity loss, cranial neuropathies, pyramidal tract dysfunction, pituitary clinical manifestations, atypical facial pain among others. Also, it has been used specially angioCT as routine after subarachnoid haemorrhage or follow-up of treated brain aneurysm [7-15].
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