手术中脑血管造影在治疗脑血管疾病中的应用

Intraoperative angiography in treatment of neurovascular disorders

目的探讨在脑血管疾病手术中脑血管造影的应用价值.方法对38例脑血管病病人在手术中进行脑血管造影.38例中男21例,女17例,年龄3岁～53岁,平均（34±9）岁.38例中动静脉畸形（AVM）27例,畸形血管团大小为2～8 cm,其中巨大AVMs（直径≥6 cm）7例（25.9%）;动脉瘤11例,其中巨大动脉瘤（直径≥2.5 cm）3例.手术前Hunt-Hess分级情况：1级4例,2级4例,3级3例.病人经气管插管全麻后经右侧股动脉插管,到达手术涉及的颅内动脉.病灶处理完毕后进行血管造影.结果 38例中9例急性颅内出血病人手术前未造影,手术中经过血管造影证实,其中7例为AVMs,另外2例证实为动脉瘤.36例（94.7%）经过造影证实病变处理满意,1例（9.0%）眼动脉瘤夹闭后有残留,重新调整动脉瘤夹;1例（3.7%）后颅窝AVM残存,病人无重要动脉被夹闭,无手术死亡病例,无造影相关并发症发生.术中血管造影需要时间为20～125 min,平均（53±22）min.结论术中脑血管造影有助于医师及时发现残余动脉瘤或AVM,载瘤动脉闭塞,立即修正技术缺陷,避免再次手术,降低手术后合并症.

Objective To investigate the value of intracperative angiography in treatment of cerebrovascular disorders. Methods Between July 2003 and July 2005, 38 consecutive patients of cerebrovascular disorders, 21 males and 17 females, aged 33. 7, 27 with arteriovenous malformations （AVMs） with a nidus 2 -8 cm in diameter among which 7 had a diameter 1〉6 cm, and 11 cases with aneurysms among which 3 cases being with an aneurysm 1〉 2.5 cm in diameter, and 4 being at the Hunt- Hess grade 1, 4 at the grade 2, and 3 at the grade 3 preoperatively, underwent cerebrovascular surgery assisted with intraoperative angiography. After intubation was achieved and general anesthesia was administrated, a catheter was inserted into the right femoral artery to the intracranial artery related to the surgery. When the lesion was managed, such as the AVMs were resected or the aneurysm was clipped, intracperative angiography was performed so as to monitor the surgical process. Results Nine of the 38 patients underwent emergency operation because of acute intracranial hemorrhage without preoperative angiography and intraoperative angiography conformed the diagnosis of AVM in 7 of them and the diagnosis of aneurysms in the other 2 patients. Intraoperative angiography showed that satisfying management was achieved in 36 of the 38 patients （94.7%） , and residue of ophthalmic artery aneurysm was seen in 1 patient which underwent clip adjustment later. Only 1 patient with posterior fossa AVM had residual AVM that was resected later. There was no operation mortality, no unexpected major artery occlusion, and no complication attributable to angiography. Intraoperative angiography lasted 53. 4 minutes （20 - 125 minutes ）. Conclusion Intraoperative angiography is able to detect unexpected residual aneurysm, AVM nidus, and major artery occlusion, helps modify the technical faults, thus preventing re-operation, and decreases the complication rate in cerebrevascular surgery.