الفهرس 
introduction
Non traumatic ( spontaneous ) subarachnoid hemorrhageOnly 14 pages are availabe for public view
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Abstract
SAH secondary to ruptured intracranial aneurysms is one of the devastating diseases to treat in neurosurgery with high rate of death and complication . So successful management of the patient needs a collective teamwork of neurosurgeons , neurologists, radiologists , anesthesiologists , intensivists and nurses. When SAH is suspected clinically, CT should be performed first. As the sensitivity of CT to detect SAH is very high . In addition , it can differentiate between aneurysmal & non aneurysmal pattern of SAH , suggest the location of the aneurysm (173) , rate the severity of SAH & predict the development of complications after the insult. DSA is considered the gold standard for diagnostic imaging of neuro-vasculature , it allows for excellent visualization of the bleeding source and the potential for endovascular intervention to prevent rebleeding , but it has invasive nature , high cost and possibly great morbidity . Increasingly , institutions using CTA in addition to or in place of traditional DSA to identify cerebral aneurysms. CTA has gained popularity owing to its non invasiveness and high sensitivity and specifity. It has a much lower risk of complications , can be performed more quickly so it is suitable for critical or unstable patients. The treatment of cerebrovascular lesions requires precise preoperative anatomic evaluation, exact information must be obtained for surgical planning regarding the whole shape of the aneurysm & its relationship to the skull base bones and surrounding vessels , this can be done by development of different imaging techniques that use CTA and apply it for evaluation of the angioarchitecture of cerebral aneurysms. The MDCT design markedly increases the volume covered and reduce scanning time, MDCT improves temporal and spatial resolution, which should increase the sensitivity of the technique in depicting small sized aneurysms. Also true isotropic imaging becomes possible , that allows the creation of 2-D images in any arbitrary plane as well as high quality 3-D images using different post processing techniques. It enables digital measurement of aneurysm dimensions in any chosen plane , by using CT software calipers , this can help in making therapeutic decision concerning whether to use surgical clipping or endovascular treatment. MSCT is very promising method for diagnosis of cerebral aneurysms in cases with SAH , as it is a useful tool for sensitive assessment of vascular structures and can describe blood vessels with high intensity, so it helps in surgical planning & choice of the most suitable therapeutic modality .