64排螺旋CT血管成像诊断永存三叉动脉

Diagnosis of persistent trigeminal artery with 64-slice spiral CT angiography

目的观察64排螺旋CT血管成像(CTA)在诊断永存三叉动脉(PTA)中的价值,提高对该血管变异的认识。方法回顾性分析2734例行头颈64排螺旋CTA检查中的5例PTA患者的影像学资料,分析PTA的发生率、起源、走行、后循环供血及合并其他血管畸形的情况。结果①PTA的发生率为0.18%(5/2734),其中3例位于右侧,2例位于左侧。②三叉动脉均起自颈内动脉海绵窦段,血管走行外侧型4例,内侧型1例;按Saltzman分型显示PTA后循环供血情况:Ⅰ型1例,Ⅱ型1例,Ⅲ型3例。③吻合点近端的基底动脉及双侧椎动脉发育不良3例,吻合点近端基底动脉完全萎缩1例;合并PTA的动脉瘤1例,合并对侧大脑中动脉成窗1例。结论 64排CTA能清晰、快速、无创、准确地显示PTA及其走行。在鞍区或鞍上区手术及介入治疗前,了解这种异常血管的有助于制定合理的手术和介入治疗方案,避免因操作不当所致的危险。

Objective To observe the application values of 64-slice spiral CT angiography （CTA） in diagnosing persistent trigeminal artery in an effort to improve the understanding of this vascular variation. Methods The imaging data of 5 patients with persistent trigeminal artery in 2734 patients who performed 64-slice CTA of craniocervical arteries were analyzed retrospectively. The incidence, origin, running, and blood supply from posterior circulation of persistent trigeminal artery, and its complicating other vascular malformations were analyzed. Results （1）The incidence of persistent trigeminal artery was 0. 18% （5/ 2734 ）. Three of them were on the right side and 2 were on the left side. （2）All the trigeminal arteries originated from the cavernous segment of internal carotid artery. Four patients were lateral type running and one （20%） was internal type running. According to Saltzman＇s classification about the blood supply in posterior circulation： one patient was Saltzman type I , one was type II , and three were type III. （3）Three patients had hasilar artery and bilateral vertebral artery hypoplasia at the point of proximal anastomosis, one had complete atrophy of basilar artery at the point of proximal anastomosis, one complicated with aneurysm of the persistent trigeminal artery, and one complicated with fenestrated middle cerebral artery on the contralateral side. Conclusions 64-slice CTA can clearly, rapidly, noninvasively, and accurately display the persistent trigeminal artery and its running. Understanding of this abnormal vessel in the sellar or suprasellar regions before surgery and interventional treatment will help develop a reasonable surgical and interventional regimen to avoid the risks caused by improper management.