Digital subtraction angiography and dynamic computed tomography for evaluating the hemodynamics in cases of giant intracranial aneurysm.

Dynamic computed tomography (CT) and digital subtraction angiography were used for postoperative evaluation of the hemodynamic changes in five patients with giant or large intracranial aneurysms. The lesions in four of these cases were giant or large aneurysms of the internal carotid artery, and were treated by occlusion of the cervical internal carotid artery and superficial temporal-middle cerebral artery anastomosis. The lesion in the fifth case was a giant aneurysm of the right vertebral artery, which was treated by proximal clipping of the vertebral artery. Preoperative digital subtraction angiography revealed aneurysmal staining, and dynamic CT scanning indicated the rapid transit of contrast medium in the dome of the aneurysm. Dynamic CT scanning immediately after operation indicated a low flow state in all of the aneurysms, suggesting that they were thrombosed. Although within a few months the peripheral edges of the aneurysms became enhanced, dynamic CT scanning revealed a slower transit of contrast medium through the centers of the aneurysms than in the basilar artery, and digital subtraction angiography failed to demonstrate aneurysmal staining, suggesting that the aneurysms remained thrombosed. The present data indicate that dynamic CT scanning and digital subtraction angiography may be useful for relatively noninvasive evaluation of the hemodynamic changes in patients with giant intracranial aneurysms.