椎动脉CT血管造影在颈椎肿瘤患者中的应用及临床意义

Usefulness of computed tomographic angiography for vertebral artery in the patients wth cervical spine tumors

目的:探讨椎动脉CT血管造影(CTA)在颈椎肿瘤患者中的应用及临床意义。方法:自2007年1月至2009年4月,对肿瘤累及一侧或双侧横突、椎间孔,与椎动脉关系密切的27例患者实施椎动脉CTA,男12例,女15例。年龄7～69岁,平均39.3岁。累及C1或C2者12例,累及下颈椎者15例。结果:1例多骨型纤维异常增殖症患者右侧椎动脉第二段自右侧C5横突孔进入。肿瘤累及右侧椎动脉者10例,累及左侧椎动脉者11例,累及双侧椎动脉者6例。未受累椎动脉通畅。14例患者的肿瘤包绕17支椎动脉,其中11例的14支受累椎动脉直径变细;8例患者肿瘤推挤10支椎动脉,其中6例8支受累椎动脉直径变细;5例肿瘤仅邻近椎动脉,未对椎动脉产生影响。椎动脉第一段受累者4例,第二段受累者10例,第三段受累者9例,同时累及第二和第三段者4例。根据肿瘤的性质实施姑息性切除、经瘤刮除或边缘切除,术中2例累及椎动脉第二、三段的脊索瘤患者一侧椎动脉破裂,行椎动脉结扎,术后无神经功能损害。结论:颈椎肿瘤常累及椎动脉,术前椎动脉CTA能够了解椎动脉与肿瘤和相邻骨结构的关系,评估受累椎动脉及对侧椎动脉通畅情况,指导术中暴露和处理受累椎动脉,避免术前椎动脉栓塞和术中预防性椎动脉结扎带来的潜在风险。

Objective：To evaluate the feasibility of using computed tomographic angiography（CTA） for vertebral artery in patients with cervical spine tumors.Method：From January 2007 to April 2009,cervical vertebra CTA was used in the patients with tumors involved in the foramen transversarium and/or intervertebral foramen on one or both sides.There were 27 patients enrolled in this study,including 12 males and 15 females with an average age of 39.3 years （ranging from 7 to 69 years）.The tumor was at C1 or C2 in 12 cases and at lower cervical spine in 15 cases.Result：One patient with polyostotic fibrous dysplasia showed V2 deformity with the right vertebral artery entering at the right C5 foramen transversarium.The vertebral arteries were compromised by the tumors on the right side in 10 cases,on the left side in 11 cases and on both sides in 6 cases.All uninvolved vertebral arteries were unobstracted.Vertebral arteries were embraced in the tumors in 14 cases （ 17 arteries）,among them the diameter of the involved artery decreased in 11 cases （14 arteries ）.The vertebral arteries were bended by the pushing of tumors in 8 cases（10 arteries）,and diameter of the involved artery decreased in 6 cases （8 arteries）.In the other 5 cases,the arteries were not affected as the tumors just located near by.Vertebral arteries were involved in V1 in 4 cases,V2 in 10 cases,V3 in 9 cases,V2 and V3 in 4 cases.Palliative,intralesional or marginal excision were undertaken according to the nature of tumors.In- traoperative vertebral artery injury occurred in 2 chordoma cases.The ruptured arteries were ligated as the opposite vertebral arteries had been shown to be patent in the preoperative CTA.No neurological complication occurred following vertebral artery ligation.Conclusion：The vertebral artery is often involved by cervical spine tumors,preoperative vertebral artery CTA is helpful to define the location of the artery to the tumor and the bony structures,and evaluate the patency of the collateral vertebral artery.It can guide the exposure and management of the arteries in the operation so as to avoid the potential riskes of pre-operational endovascular occlusion and intra-operational preventative ligation.It is safe to ligate the injured vertebral artery if the collateral artery is patent in preoperative CTA.