The role of three-dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional "gold standard", i.e. digital subtraction angiography (DSA). We study the technology used at a tertiary care hospital in Japan which performs a large number of aneurysm surgeries a year and review the recent literature to gain an insight into the current role of 3D-CTA in detection of aneurysms and if it can be a front line modality of investigation from a neurosurgeon's point of view. At many centres including those in India, DSA is still treated as the first choice of investigation. Although 3D CTA has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. This may provide an invaluable help to a neurosurgeon who is usually concerned about many other associated factors involved in approaching an aneurysm.
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