壁内出血起病的后交通动脉夹层动脉瘤1例

颅内动脉瘤破裂多以蛛网膜下腔出血（subarachnoid hemorrhage，SAH）起病，可伴有脑内血肿（intracerebral hematoma，ICH）或／和脑室内出血（intraventricular hemorrhage，IVH）。而以壁内出血（intramural hemorrhage，IMH）无SAH的颅内破裂动脉瘤罕见，作者收治1例报告如下。     

CT鉴别诊断颅内动脉瘤栓塞术后对比剂残留与蛛网膜下腔出血

目的观察CT鉴别颅内动脉瘤电解可脱式铂金弹簧圈（GDC）栓塞术后对比剂残留与蛛网膜下腔出血（SAH）的诊断价值。方法回顾性分析55例SAH患者及45例颅内未破裂动脉瘤GDC栓塞术后患者的CT特征。结果55例SAH患者中,出血以鞍上池（44／55,80．00％）、外侧裂（25／55,45．45％）分布为主;45例颅内未破裂动脉瘤GDC栓塞术后患者颅内高密度分布以静脉窦（39／45,86．67％）、后纵裂（20／45,44．44％）、小脑幕（18／45,40．00％）分布为主;GDC栓塞术后脑内高密度CT值升高明显,平均值大于75HU,与SAH比较边界相对清晰,对脑裂、脑池及静脉窦正常形态影响小。结论CT显示的病灶分布部位、密度、形态有助于鉴别GDC栓塞术后对比剂残留造成的颅内高密度影与动脉瘤破裂出血导致的SAH。     

螺旋CT对胰腺炎血管并发症的诊断价值

目的：探讨急、慢性胰腺炎血管并发症的CT表现，评价螺旋CT对其诊断价值。方法：对316例急、慢性胰腺炎患者的临床资料和CT表现作对照分析。重点观察有腹腔出血和腹腔血管异常胰腺炎患者的CT表现，测量腹腔出血患者的腹腔血性积液的CT值，同时分析CT增强中胰周血管的动脉瘤、静脉血栓和静脉曲张等。结果：316例胰腺炎中有急性胰腺炎275例，慢性胰腺炎4l例。急性胰腺炎中出现腹腔血管并发症者共20例，其中13例腹腔大出血患者(含5例合并消化道大出血)中，11例CT诊断正确，CT表现为腹腔内局限性或弥漫性稍高密度积液。2例未检出；7例单纯上消化道大出血者，CT扫描可见胃底静脉曲张4例。慢性胰腺炎组中，CT发现l例为腹腔动脉假性动脉瘤，l例为脾动脉假性动脉瘤，另1例脾静脉血栓者可见胃底静脉曲张。结论：(1)胰腺炎患者腹腔内局限性或弥漫性稍高或高密度积液为腹腔内出血较常见的CT表现；(2)螺旋CT增强扫描能显示胰周血管的假性动脉瘤；(3)胃底静脉曲张和胰腺体尾部坏死常强烈提示脾静脉血栓形成。     

原发性肝癌自发性破裂腹腔内出血53例诊治体会

目的探讨原发性肝癌自发性破裂腹腔内出血的临床特点和手术治疗方法。方法回顾性分析我院1998～2007年收治的53例经手术证实的原发性肝癌自发性破裂腹腔内出血患者的临床资料，结合文献复习进行讨论。结果53例患者均以突发性腹痛为首发症状，有前期症状者33例，无症状者20例；有外伤史者（左上腹或季肋区）6例；有腹膜炎体征46例，腹腔穿刺抽出不凝血41例，合并休克29例。术前误诊16例。行急诊手术48例，施行肝切除33例。术后肝功能不全34例，其中3例死于肝功能衰竭。术后生存3d～78个月，平均34．6个月。结论原发性肝癌自发性破裂腹腔内出血多以腹痛为首发，常以血性腹膜炎表现为特点，术前误诊率较高；手术方式根据病变位置、大小，肿瘤是否局限、转移和肝硬变程度决定。术后近期死亡原因主要是肝功能衰竭，远期死亡原因主要是复发转移。     

动脉瘤性蛛网膜下腔出血的早期诊断及治疗

目的探讨动脉瘤性蛛网膜下腔出血（SAH）的早期诊断方法及治疗原则,并客观评价其治疗效果。方法对SAH患者采用影像学检查,结合病史、临床表现进行早期病因诊断;并对96例动脉瘤早期采用电解可脱性弹簧圈进行囊内栓塞;术后早期对症治疗。结果96个动脉瘤均被早期诊断并成功栓塞,其中100％闭塞者83个,95％闭塞者8个,90％闭塞者5个。术中并发动脉瘤破裂3例;并发脑血管痉挛5例;术后1例弹簧圈末端逸出;3例复发者均经二次补充电解可脱性弹圈（GDC）栓塞治愈。全组出现与栓塞技术相关的并发症9例;与SAH有关的永久性后遗症13例（13．5％）。Glasgow预后评分：Ⅰ级77例、Ⅱ级7例、Ⅲ级6例、Ⅳ级3例、Ⅴ级3例,死亡率3．1％。结论对破裂的动脉瘤性SAH进行早期病因学诊断,并采用电解可脱性弹簧圈进行动脉瘤囊内栓塞,术后积极对症治疗是提高动脉瘤性SAH治愈率和降低死亡率、致残率的重要方法。     

肝移植受者合并脾动脉瘤的临床特点与诊治经验

目的 总结肝移植受者合并脾动脉瘤的临床特点和诊治经验.方法 回顾性分析2001年12月至2003年12月天津市第一中心医院移植外科实施的450例肝移植受者的临床资料、四期CT扫描及CT血管造影资料,并对临床及随访资料进行统计学分析.结果 450例受者中有20例(4.4%)被确诊合并脾动脉瘤,其中19例术前通过四期CT扫描确诊,1例为术中发现.肝移植术中未处理脾动脉瘤15例,其中2例于术后发生脾动脉瘤破裂出血,均予急诊手术(其中1例死于失血性休克).肝移植术中切除脾动脉瘤及脾脏5例,术后恢复顺利,移植肝功能良好.结论 肝硬化患者易合并发生脾动脉瘤,四期CT扫描能够准确诊断脾动脉瘤.肝移植术后早期易发生脾动脉瘤自发破裂,术中应同期予以处理.     

脾动脉瘤的诊断和治疗

目的：总结16例脾动脉瘤的外科诊治经验。方法：回顾性分析收治的16例脾动脉瘤患者的临床资料。其中男4例,女12例,经超声多普勒、CT血管造影（CTA）等检查发现脾动脉瘤15例,另1例术中探查发现。手术治疗11例,其中脾动脉瘤破裂行急诊手术4例,择期性手术7例,手术包括脾动脉瘤及脾切除9例,同时切除胰尾3例,脾动脉瘤切除、脾动脉重建1例,脾动脉瘤切除、近远端脾动脉结扎1例。另外行脾动脉瘤介入栓塞3例,非手术治疗2例。结果：手术及介入治疗的14例患者治疗后未发生严重的并发症,无死亡,均康复出院。术后随访0.5~19.0年,平均8.4年。11例手术及介入治疗者中,2例分别手术后3,7年死于其他疾病,另9例情况良好。2例非手术治疗者已分别随访3,5年,脾动脉瘤无变化。结论：脾动脉瘤女性多发;CT血管造影和多普勒超声等可明确诊断;早期切除动脉瘤或介入栓塞术是防止破裂出血导致死亡的有效方法。     

动脉瘤的诊断和治疗

动脉瘤是动脉管壁的先天或后天异常所引起的病理改变，表现为动脉扩张或膨出。动脉瘤只增大而不缩小，只会破裂而不能自愈，尤其是治疗风险很大的颈动脉瘤（向咽部破裂者，患者会立即窒息死亡）或夹层动脉瘤（破裂至心包和胸腔者则难以得救），谁得了它，均自然而然地想得到治愈。从历史眼光说，早年敢于以颈动脉结扎术治疗此病者，已有很大贡献——尽管死亡率可高达30％!但问题在于如不予治疗，其自然死亡率高达70％。因而自1805年Cooper首次施行此术以来沿用了150余年。如果与30％的死亡率有关者均与医院发生医疗纠纷，想必此术不可能坚持150年之久。何况在特殊情况下，此术在今天仍被采用，如颈动脉瘤急性破裂和瘤体深居颅底，但条件和医技达不到瘤体切除和颈动脉重建时也只好如此。对于必须治疗的动脉瘤，医生要发扬救死扶伤、实行革命人道主义之责任，精益求精，全力减少治疗中的死亡率和颅脑并发症的发生率，但国人也应理解治疗中的困难和风险，要了解历史和现状，解除医生的顾虑，如同走路一样，在平地上走和在独木桥或钢丝上走是迥然不同的。现以风险大而易产生纠纷的颈动脉瘤的诊断、治疗为例加以简述。     

11例腘脉瘤的诊断与治疗

目的对我院诊治的腘动脉瘤病例进行总结。方法查阅我院1975～2004年11例腘动脉瘤患者病历，对其资料进行分析。结果本组患者11例、患肢11条，常见的临床表现依次为腘窝搏动性肿块、跛行、伸膝困难、肿块疼痛等，动脉瘤破裂3例（27．3％）。接受的特殊检查有动脉造影、彩色多普勒。10例行手术治疗，手术方式包括：动脉瘤内缝合修补术4例；动脉瘤切除、血管移植术6例。病理结果：假性动脉瘤3例、梅毒性动脉瘤3例、动脉粥样硬化性动脉瘤4例。1例动脉瘤内缝合修补术后出现患侧小腿干性坏疽而行患侧大腿下1／3截肢术。1例全身情况太差而未接受手术者死于心功能衰竭、晚期梅毒。术后随访1．5～30年，另外3例接受动脉瘤内缝合修补术患者中1例有间歇性跛行；1例患肢足背动脉能扪及搏动，无肢体缺血表现；1例失访。6例接受动脉瘤切除、血管移植术患者中，1例失访（Dacron人造血管移植）；1例有间歇性跛行；4例患肢足背动脉能扪及搏动，无肢体缺血表现。结论推广彩色多普勒在人群筛查中的应用可能有助于腘动脉瘤的检出。有症状的腘动脉瘤及直径大于3cm的无症状腘动脉瘤应接受手术，直径小于或等于3cm的无症状腘动脉瘤可定期随访观察。     

骨骼肌肌肉内血管瘤

目的：探讨肌肉内血管瘤（intramuscular hemangioma,IMH)的诊断、治疗与误诊的原因。方法：收集自1962年10月－1998年12月术后经病理证实、110例资料完整的IMH病例，分析发病年龄、性别、分类、临床状与体征，以及X线片，CT、SPECT、MRI与超声检查的临床价值，描述其手术方法，病理学分类，手术效果与复发原因，提出鉴别诊断，并发症及复发的预防措施，结果：解剖分布：颈部占11．82％，躯干占10．91％，上肢占16．36％，下肢占60．91％， 以局部性疼痛，深压痛，运动或劳累后肿块增大，疼痛加重为主要症状与体征；可分为毛细血管，海绵状，混合三类、混合型IMH常存在静脉型，上皮样型与肉芽肿等血管瘤的组织学表现，毛细管型IMH42例（38．18％），海绵状IMH37例（33．64％），混合型IMH31例（28．18％），随访49例，占44．55％，。术后疗效优24例（48．98％），良11例（22．45％），不满意10例（20．41％），差4例（8．16％），结论：体积小而深同时合并纤维、脂肪、瘢痕增生的混合型IMH易误诊，行MR检查能够诊，核素显像参考价值。IMH增大可压迫神经引发疼痛，一般不侵犯神经组织，手术治疗最为理想，主张将IMH相关血管结扎，手术不彻底易引起复发，难以切除的残余肿瘤可以行血管硬化剂等方法治疗；IMH易感染但不会产生恶变，反应区相关血管的结扎对预防肿瘤复发，减少术中出血有重要作用。     

Intracerebral hematomas caused by aneurysm rupture. Experience with 67 cases

During a six-year period (1986–1992) 334 patients with subarachnoid hemorrhage (SAH) were admitted to the Department of Neurosurgery, Medical University of Lübeck, Germany. In 281 patients the SAH was caused by rupture of an intracranial arterial aneurysm, verified by angiography, postmortem examination, or at emergency operation without angiography. In 67 (23.8 %) of the 281 aneurysmal SAH patients the initial computerized tomography (CT) demonstrated an intracerebral hematoma (ICH). An ICH localized in the temporal lobe due to the rupture of a middle cerebral artery (MCA) aneurysm was found in 47 patients (70.2 %). Forty-three patients were considered for surgery with a surgical mortality of 8 (18.6 %). In the group of 19 ICH patients not operated upon, 16 individuals died (84.2%).We therefore advocate active surgical management of ICH patients: hematoma evacuation and aneurysm clipping at the same operation. Emergency surgery in younger patients (grade V) with temporal ICH suggesting the rupture of a MCA or internal carotid artery (ICA) aneurysm can be done without angiography.     

Ruptured internal carotid artery bifurcation aneurysm presenting with only intracerebral hemorrhage without subarachnoid hemorrhage--case report

A 55-year-old man presented with intracerebral hemorrhage (ICH) without subarachnoid hemorrhage (SAH) manifesting as acute onset of consciousness disturbance and right hemiparesis. Computed tomography showed ICH mainly localized in the left putamen, but no evidence of SAH. Magnetic resonance angiography demonstrated a cerebral aneurysm originating from the bifurcation of the left internal carotid artery, which was considered to be responsible for the ICH. The patient underwent emergent intravascular surgery for coil embolization of the aneurysm, and his neurological symptoms gradually recovered with rehabilitation after surgery. Although ICH without SAH is a rare presentation of cerebral aneurysm, ruptured cerebral aneurysm should be considered as a potential cause of ICH. The localization and extent of ICH may be suggestive of latent cerebral aneurysm in such cases.     

Intracerebral haematomas from aneurysm rupture: Their clinical significance

Summary Two series of patients (814 cases altogether) with ruptured intracranial aneurysms are analyzed in order to try to outline the clinical significance of space-occupying intracerebral haematomas (ICH) which may accompany SAH. In particular the question of whether intracerebral clots are or are not to be taken into account in planning emergency surgery is debated.From the reported series, it would appear that ICH after aneurysm rupture seldom lead to increasing intracranial hypertension warranting urgent surgery. This evolution was observed in approximately 5% of patients with expanding ICH. In 35% the intracerebral effusions were associated with irreversible lesions and in 20% the initial symptomatology definitely improved. Finally, in a relatively high percentage of cases (about 40%) ICH lacked of clinical significance.Brandtet al. [Brandt L, Sonesson B, Ljunggren B, Saveland H (1987), Ruptured middle cerebral artery aneurysm with intracerebral haemorrhage in younger patients appearing moribund: emergency operation, Neurosurgery 20, 925–929] have just reported 4 cases of huge ICH from ruptured MCA in young moribund patients successfully submitted to ultraemergency surgery, on the basis of CT alone without angiography. 3 patients survived with moderate disability. This report would indicate unsuspected therapeutic possibilities in some hyperacute cases. Unfortunately, the circumstances which had been given in the cases reported by Brandtet al. are seldom gathered.     

Midaortic syndrome and subarachnoid hemorrhage associated with ruptured middle cerebral artery aneurysm: case report and review of the literature

OBJECTIVE AND IMPORTANCE: We describe the presentation, screening, management, and clinical outcome of a 21-year-old man who sought care for a ruptured middle cerebral artery (MCA) aneurysm and midaortic syndrome (MAS). Only three cases of MAS and intracranial aneurysm rupture have previously been described in the literature. CLINICAL PRESENTATION: Cranial computed tomographic (CT) scanning, cerebral and abdominal angiography, and multislice three-dimensional CT angiography were used to evaluate intracerebral hemorrhage and to assess medically intractable hypertension in the patient. Digital subtraction angiography revealed a right MCA aneurysm, and multislice three-dimensional CT angiography revealed narrowing of the abdominal aorta. INTERVENTION: The patient's right MCA aneurysm was successfully clipped via a right pterional craniotomy. A narrowed abdominal aorta was confirmed by an abdominal aortic angiogram (performed at Day 5 after surgery) and then dilated by using percutaneous transcatheter angioplasty during the same session. The patient was normotensive even without antihypertensive medications. Neurological examination and postoperative cranial CT findings were within normal limits at the last follow-up examination, performed 4 months after the operation. CONCLUSION: Our patient is the first reported case of ruptured MCA aneurysm with MAS in an adult. The most important problem in the management of MAS associated with ruptured intracranial aneurysm is medically intractable hypertension, which may markedly increase the incidence of rebleeding. It is hard to achieve normotension unless the narrowed aorta and its branches are dilated. For these reasons, MAS should be considered in patients with medically intractable hypertension associated with ruptured intracranial aneurysm.     

Subarachnoid hemorrhage of unknown origin. Longterm prognosis

Patients suffering subarachnoid hemorrhage in whom angiography does not initially show vascular malformation and CT scan rules out an intracranial tumor, have, reportedly, a good prognosis with a rate of recurrent hemorrhage of about 2–10% within a follow-up time of up to 15 years. Most authors denied indication for control angiography. In order to study the benefit of control angiography performed after 4-6 weeks, four-hundred eigthy-three patients with SAH but without ICH were reviewed, and the longterm clinical course of 98 patients with SAH of unknown origin treated in our department between 1976 and 1988 was investigated. Among 183 patients who underwent control angiography, a second angiography showed an aneurysm in 143. The third angiography was positive in a further 18 patients. Recurrent SAH occurred early only in patients who had undergone only one angiography. One patient died from intracerebral hemorrhage of unknown origin two years following SAH. These data support the need for control angiography in cases of SAH.     

Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms

OBJECT: Some authors have questioned the need to perform cerebral angiography in patients presenting with a benign clinical picture and a perimesencephalic pattern of subarachnoid hemorrhage (SAH) on initial computerized tomography (CT) scans, because the low probability of finding an aneurysm does not justify exposing patients to the risks of angiography. It has been stated, however, that ruptured posterior circulation aneurysms may present with a perimesencephalic SAH pattern in up to 10% of cases. The aim of the present study was twofold: to define the frequency of the perimesencephalic SAH pattern in the setting of ruptured posterior fossa aneurysms, and to determine whether this clinical syndrome and pattern of bleeding could be reliably and definitely distinguished from that of aneurysmal SAH. METHODS: Twenty-eight patients with ruptured posterior circulation aneurysms and 44 with nonaneurysmal perimesencephalic SAH were selected from a series of 408 consecutive patients with spontaneous SAH admitted to the authors' institution. The admission unenhanced CT scans were evaluated by a neuroradiologist in a blinded fashion and classified as revealing a perimesencephalic SAH or a nonperimesencephalic pattern of bleeding. Of the 28 patients with posterior circulation aneurysms, five whose grade was I according to the World Federation of Neurosurgical Societies scale were classified as having a perimesencephalic SAH pattern on the initial CT scan. The data show that the likelihood of finding an aneurysm on angiographic studies obtained in a patient with a perimesencephalic SAH pattern is 8.9%. Conversely, ruptured aneurysms of the posterior circulation present with an early perimesencephalic SAH pattern in 16.6% of cases. CONCLUSIONS: This study supports the impression that there is no completely sensitive and specific CT pattern for a nonaneurysmal SAH. In addition, the authors believe that there is no specific clinical syndrome that can differentiate patients who have a perimesencephalic SAH pattern caused by an aneurysm from those without aneurysms. Digital subtraction angiography continues to be the gold standard for the diagnosis of cerebral aneurysms and should be performed even in patients who have the characteristic perimesencephalic SAH pattern on admission CT scans.     

Dissecting aneurysms of the anterior cerebral artery and accessory middle cerebral artery. Case report

A 66-year-old woman presented with dissecting aneurysms of the anterior cerebral artery (ACA) and accessory middle cerebral artery (MCA) manifesting as subarachnoid hemorrhage but without radiological evidence of the dissecting aneurysms. Intraoperative observation revealed that the vessel walls were dark purple in color, a typical finding of dissecting aneurysm. The abnormal A1 segment was trapped and the dissecting aneurysm of the accessory MCA was wrapped. In the case of SAH of unknown origin, dissecting aneurysm should always be kept in mind even if the angiogram does not show any abnormal finding. This is the first reported case of dissecting aneurysm of the accessory MCA.     

Computed tomography in the diagnosis of hemorrhage secondary to intracranial aneurysm. (author's transl)

In 168 patients with ruptured intracranial aneurysms, the pathology of intracranial hemorrhage visualized on CT was analyzed. Blood in the subarachnoid space could be visualized in 95% of cases within three days after SAH and 75% of 106 cases within two weeks after SAH. In one case blood clot in the subarachnoid space visible up to 13 days after SAH. Concerning the cases within two weeks after the bleeding, intracerebral hematomas were observed in 36% of anterior cerebral aneurysms and middle cerebral aneurysms, 16% of internal carotid aneurysms and none of vetebro-basilar aneurysms. The incidence of the intraventricular hemorrhage was as follows; vertebro-basilar, 44%; anterior cerebral, 38%; internal carotid, 28%; middle cerebral, 12%. On the basis of the pattern of distribution of extravasated blood the location of the ruptured aneurysm was properly predicted in 58% of anterior cerebral, 81% of middle cerebral, 58% of internal carotid and 30% of vertebro-basilar. Especially CT could contribute to predict which aneurysm has ruptured in patients with multiple aneurysms. It was possible to localize the site of bleeding in 11 out of 12 CT positive cases. The development of intracranial hemorrhage demonstrated by CT well correlated with the clinical grading of the patients and the clinical outcome. Patients merely showing subarachnoid hemorrhage were more likely to have good neurological grades, but ones showing complicated intracerebral hematomas and intraventricular hemorrhage had poor neurological grades at the time of the scan. The findings of extensive subarachnoid clot, which were followed by severe vasospasm, and marked intraventricular hemorrhage, usually correlated with poor prognosis. These pathology recognizable on CT was very helpful in determination of the timing of surgery and management of such patients. In conclusion CT is of great value in the examination of SAH when performed in the acute stage and should be the initial examination followed by angiography.     

Cerebral aneurysms in identical twins

The hypothesis that genetic factors play a role in the genesis of cerebral aneurysms may be supported by clinical analysis of cerebral aneurysms in identical twins. In addition to reporting the present case, we review the literature on clinical features and genetical considerations in this matter. A forty-two-year-old male presented with subarachnoid hemorrhage (SAH) due to a left MCA aneurysm. At the age of 39, his identical twin brother also had SAH due to a ruptured left MCA aneurysm. This identical twin brother and his father's sisters died of SAH. Venous blood of the patient and his parents was collected to determine apolipoprotein E, angiotensinogen, angiotensin-converting enzyme, and very low density lipoprotein receptor genes. This analysis suggested a strong genetic association of apolipoprotein E epsilon4 with the pathogenesis. Including our cases, 13 cases of cerebral aneurysms in identical twins have been reported. There was a total of 37 aneurysms. Six twins had the same sites of aneurysm. These aneurysms show a tendency to be small in size, and to cause a high frequency of SAH occurring at a similar age. In young adults, cerebral aneurysms in identical twins tend to rupture. A screening diagnosis should be carried out as early as possible on an asymptomatic twin when the other has been discovered to have a ruptured cerebral aneurysm. Preventive treatment and systemic genome-wide linkage study should be conducted.     

Usefulness of CT angiography for demonstrating cerebral aneurysms

We report the usefulness of computed cerebral angiotomography (CT angiography) for demonstrating cerebral aneurysm and the clinical significance of CT angiography for ruptured cerebral aneurysm. Our modified method of CT angiography was easy and less time-consuming. Fifteen seconds after starting a single bolus injection, 1 ml/kg/25 seconds via cubital vein, of contrast medium (60% urograffin), 5 serial 5 mm thick-CT slices were scanned in every 6.5 seconds including 2 seconds of interval, beginning from an axial level 20 mm above the orbitomeatal line and ending at a level 40 mm. A total of 103 patients were examined in this report, consisting of 70 unruptured asymptomatic, 8 unruptured symptomatic (oculomotor nerve palsy) and 25 subarachnoid hemorrhage (SAH). Seven unruptured aneurysms in 4 asymptomatic cases, 2 unruptured aneurysms in 2 symptomatic cases 27 aneurysms in 24 SAH cases were suspected by CT angiography. Of these 36 aneurysms suspected by CT angiography 32 aneurysms were confirmed by cerebral angiography. The detection rate of CT angiography in this report was 89%, higher than those of previous reports. Thirteen aneurysms were located at internal carotid-posterior communicating artery (ICPC) junction. 11 at anterior communicating artery (Acom), 7 at middle cerebral artery (MCA). CT angiography showed a false positive findings in 4 cases, which were all located at Acom. Four aneurysms were not detected in CT angiography, which were all located at MCA and were very small (2-3 mm) in diameter. There were no deteriorated cases during and after CT angiography. We suggest that CT angiography is a useful and safe method for predicting the location of not only unruptured but ruptured aneurysms.