多层螺旋CT模拟前床突切除术扩大颈内动脉虹吸部的暴露范围

Multislice Spiral CT-based Simulation in Enlarging Exposure Extent of Internal Carotid Artery Siphon Before and After Removing Anterior Clinoid

目的应用多层螺旋CT(MSCT)在活体个性化模拟前床突切除术扩大颈内动脉虹吸部的暴露范围,提高该区肿瘤切除率,保证手术效果。资料与方法对100例受检者(200侧)在MSCT三维重建图像上模拟眶上锁孔手术入路进行观察,并测量前床突去除前后大脑前中动脉分叉处距所观察到的颈内动脉虹吸部最近心点的曲线距离(暴露长度)。结果 100例(200侧)在影像上模拟眶上锁孔手术入路测量前床突去除前后左侧暴露长度分别为(14.3±3.9)mm、(30.5±4.2)mm,右侧分别为(15.9±3.8)mm、(31.8±3.9)mm,差异均有统计学意义(t=45.278、40.513,P<0.001);前床突去除前后左、右侧暴露长度分别增加(16.3±3.6)mm、(15.8±3.9)mm,差异无统计学意义(t=0.251,P>0.05)。结论 MSCT活体个性化模拟眶上锁孔入路前床突切除术可以有效增加颈内动脉的暴露长度,并扩大鞍区的暴露范围,为该区肿瘤切除及治疗方案的选择提供可靠的影像学信息。

Purpose To study the exposure extent of internal carotid artery siphon （ICAS） before and after removing anterior clinoid process （ACP） using multislice spiral CT （MSCT） simulation, and to improve the ttunor resection rate and ensure the operation effect. Materials and Methods MSCT three-dimensional ilnages reconstruction simulating supraorbital keyhole approach of 100 patients （200 sides） were observed, the distance between the crotch of anterior cerebral artery and middle cerebral artery and ICAS before and alter removing ACP （exposure extent） was measured. Results In 100 patients （200 sides ACP）, the exposure extent belg,）re and after removing ACP were （14.3 ± 3.9） mm and （30.5±4.2） ram, respectively on the left side with statistical difference （t-45.278, P〈0.001 ）, and were （15.9±3.8） mm and （31.8± 3.9） ram, respectively on the right side with statistical difference （t=40.513, P〈0.001 ）. The exposure extent increased （ 16.3 ±3.6） mm and （15.8±3.9） nnn, respectively on the left and right side with no statistical difference （t-0.251, P〉0.05）. Conclusion MSCT simulating supraorbital keyhole approach in removing ACP can effectively increase the exposure length of ICA, and enlarge the exposure extent of sella region, thus provide reliable imaging information for removing tumor and selecting surgical project in this region.