应用三维CT血管造影模拟颅内动脉瘤手术入路

Three-dimensional CT angiography simulates operative approaches for intracranial aneurysms

目的:应用三维CT血管造影(3D-CTA)模拟颅内动脉瘤手术入路,探讨颅内动脉瘤破裂开颅手术治疗中颅脑3D-CTA的应用价值。方法:选择经手术证实的颅内动脉瘤破裂致蛛网膜下隙出血患者134例,术前均行3D-CTA检查并进行动脉瘤手术模拟,部分患者术前行DSA检查;将患者的术前CTA与术前DSA、术中所见进行比较,分析颅脑3D-CTA的临床应用价值。结果:134例患者共有动脉瘤163枚,3D-CTA发现162枚,诊断阳性率为99.4%,特异性100%;术前3D-CTA能清晰地显示动脉瘤位置、大小、形态、瘤顶指向、瘤颈宽窄、载瘤动脉、动脉瘤与周围血管及骨结构关系,且与术中所见基本一致;术中134例患者在探查动脉瘤时均未发生动脉瘤破裂出血,出院时GOS预后评分:5分85例、4分22例、3分17例、2分6例、1分4例。结论:作为术前常规检查的3D-CTA对颅内动脉瘤进行开颅夹闭术的模拟,有助于颅内动脉瘤手术入路的设计,从而提高手术的成功率。

Objective： To simulate the surgical approaches for intracranial aneurysms using three-dimensional CT angiography （3D-CTA）,so as to assess the value of 3D-CTA in the microneurosurgery for ruptured intracranial aneurysms. Methods： Totally 134 patients with spontaneous subarachnoid hemorrhage caused by ruptured intracranial aneurysm were confirmed by operation. All the patients were examined by CTA before operation and surgical simulation was conducted. Some patients were examined by the pre-operative DSA （digital subtract angiography）. The findings of pre-operation CTA,DSA and intra-operative findings were compared and the clinical value of cerebral 3D-CTA was analyzed. Results： 3D-CTA discovered 162 aneurysms out of a total of 163 in 134 patients. The sensitivity and specificity of 3D-CTA for diagnosis of ruptured intracranial aneurysm were 99.4% and 100%, respectively. Moreover, pre-operation examination with 3D-CTA clearly displayed the location,size,and shape of aneurysms, the axis direction of the aneurysmatic summits and the width of aneurysmatic neck. Furthermore, the spatial relations between the parent aneurysm artery, the aneurysm, the periphery vessel and bony structures were also demonstrated. These findings were in accordance with the intra-operative findings. There was no rupture during exploration. The Glasgow outcome score was 5 in 85 patients,4 in 22,3 in 17,2 in 6,and 1 in 4. Conclusion： The conventional pre-operative 3D-CTA examination can simulate surgery for patients with ruptured intracranial aneurysms, and it can help to design the operative approach and improve the successful rate of operation.