Abstract
Objective: The aim of this study was to report a case that underwent a craniotomy after primary pre-operative cerebrovascular and 3D digital subtract angiography (DSA) showed wrong outcomes. DSA misdiagnosis and missed diagnosis of aneurysms were found, and the subject was subsequently treated correspondingly. This case was analysed to identify 1) the cause of the false positive and false negative results in DSA, 2) the limitations of 3D DSA and 3) the experience and lessons learned.
Methods: A 54-year-old spontaneous subarachnoid haemorrhage patient underwent DSA and 3D DSA under local anaesthesia. Results revealed aneurysm at the anterior cerebral A1 end. Considering the excessively large tumour angle circuitry, we decided to adopt craniotomy and clipping under direct vision. Misdiagnosis and missed diagnosis were intra-operatively noticed, and the aneurysm was clipped out. About half a month after the operation, the patient underwent DSA again under full coordination. The results from these two DSAs were compared.
Results: An originally suspected aneurysm was merely a pseudo-anterior communicating artery; the real aneurysm was located in the starting zone of A1. Active cooperation (or anaesthesia) made 3D DSA clear and complete. Moreover, the two 3D DSAs were both ineffective in identifying false positive aneurysms because of anatomical variation.
Conclusions: 3D DSA is still limited in differentiating or developing anatomical variations of cerebrovascular vessels, thereby causing false positive results. The use of 3D DSA requires full cooperation from the patient. The guiding effect of the clot accumulation area on aneurysms should be considered during operation.
Manuscripts that are Published Ahead of Print have been peer reviewed and accepted for publication by the Editorial Board of the West Indian Medical Journal. They may appear in their original format and may not be copy edited or formatted in the style guide of this Journal. While accepted manuscripts are not yet assigned a volume, issue or page numbers, they can be cited using the DOI and date of e-publication. See our Instructions for Authors on how to properly cite manuscripts at this stage. The contents of the manuscript may change before it is published in its final form. Manuscripts in this section will be removed once they have been issued to a volume and issue, but will still retain the DOI and date of e-publication.
Our 7 faculties and 12 professional schools offer more than 200 programmes to some 18,000 graduate, undergraduate and continuing studies students.
The UWI, Mona ranks first in Jamaica among accredited tertiary-level programmes. In 2012, the University was again one of Jamaica’s Top 100 Employers.
