CT血管成像在床突旁动脉瘤诊断治疗中的应用

The application of CTA in the diagnosis and treatment of paraclinoid aneurysms

目的探讨64层螺旋CT血管成像（CTA）在床突旁动脉瘤诊断和治疗中的应用。方法回顾分析经数字减影血管造影术（DSA）证实的22侧床突旁动脉瘤患者，术前均行CTA检查。根据DSA及CTA检查制定手术方案，术后复查CTA以判断动脉瘤夹闭情况。结果CTA显示24枚动脉瘤，漏诊1枚颈动脉窝和1枚颈内动脉后壁动脉瘤。其中22枚动脉瘤行动脉瘤夹闭术；1枚行包裹术；1枚眼动脉瘤行动脉瘤孤立加颅内外血管架桥术；2枚对侧眼动脉段动脉瘤未处理。术后14例复查CTA，4例复查DSA，4例拒绝复查。复查CTA证实13例动脉瘤完全夹闭，1例架桥术后血管通畅。结论CTA对于判断前床突、视嵴、视神经管上壁等骨性结构是否需要磨除、动脉瘤是否可以夹闭及动脉瘤与周围血管结构的关系有重要的参考价值；CTA也是动脉瘤术后复查的重要手段。

Objective To study the application of computed tomography angiography （CTA） in the diagnosis and treatment of paraclinoid aneurysms. Methods Twenty-two patients with paraclinoid aneurysms identified by digital subtraction angiography（DSA） were analyzed retrospectively. All the patients underwent CTA examination preoperatively. Surgical plans were made according to the findings in DSA and CTA. The CTA was performed postoperatively to confirm the complete obliteration of the aneurysms. Results CTA found 24 aneurysms,1 missed carotid cave aneurysm and 1 missed internal carotid artery posterior wall aneurysm. Twenty-two aneurysms were directly clipped, 1 carotid cave aneurysm was wrapped and 1 ophthalmic artery aneurysm was trapped with extracranial-intracranial revascularization,2 contralateral ophthalmic aneurysms were left alone. Postoperatively, 4 patients underwent DSA examinations, 14 patients underwent CTA examinations which indicated that 13 aneurysms were completely excluded from the circulation and 1 bypass vessel was patent. Four patients rejected the DSA or CTA examination. Conclusion CTA is great helpful to making decision whether the anterior clinoidal process,optic strut, and roof of optic canal should be removed, and whether the aneurysm can be clipped. CTA also plays a role in identifying the relationship between the aneurysm and surrounding vascular structures.