3D-DSA、CTA在颅内动脉瘤个体化锁孔手术中的应用价值

Applied values of three-dimensional digital subtraction angiography and CT angiography in individualized keyhole operation of intracranial aneurysms

目的探讨三维数字减影血管造影（3D—DSA）、多排螺旋CT血管成像（CTA）技术对锁孔手术治疗颅内动脉瘤的应用价值。方法福建医科大学附属第一医院神经外科自2007年4月至2009年6月应用3D—DSA、CTA技术分析动脉瘤的影像学特征，个体化设计锁孔手术并治疗颅内动脉瘤患者175例（192个动脉瘤1，其中眶上锁孔入路38例（40个动脉瘤1，翼点锁孔入路132例（146个动脉瘤），额锁孔纵裂入路3例（4个动脉瘤），颞下锁孔入路2例（2个动脉瘤），分析3D—DSA、CTA在颅内动脉瘤锁孔手术策略中的应用与意义。结果本组患者均一次性成功完成手术，其中动脉瘤夹闭188个，动脉瘤包裹4个。术后复查DSA或CTA显示动脉瘤均夹闭满意。GOS评分显示术后良好165例，轻残6例，重残2例，死广2例。结论3D．DSA、CTA可清晰显示颅内动脉瘤三维形态特征，为个体化的锁孔手术入路设计提供依据，是手术成功的前提。

Objective To explore the values of three-dimensional digital subtraction angiography （3D-DSA） and CT angiography （CTA） in keyhole surgery of intracranial aneurysms. Methods A retrospective analysis of 175 patients with 192 intracranial aneurysms, treated by keyhole approaches in our hospital from April 2007 to June 2009, was performed. The imaging features of the aneurysms via 3D-DSA and CTA were analyzed; the designed individualized approaches were performed on these patients： supraorbital keyhole approach in 38 patients （40 aneurysms）, pterion keyhole approach in 132 patients （146 aneurysms）, inferior-ten-lporal keyhole approach in 2 （2 aneurysms） and trans-frontal keyhole longitudinal fissure approach in 3 （4 aneurysms）. The application and significance of 3D-DSA and CTA in keyhole surgery of intracranial aneurysms were summarized. Results All 175 patients successfully finished the one-time surgery： 188 aneurysms were clipped and the other 4 were wrapped. All the aneurysms enjoyed satisfactory clipping under DSA or CTA. According to the modified GOS scores, good result was achieved in 165 patients, mild disability in 6, severe disability in 2, and death in 2. Conclusion 3D-DSA and CTA can clearly show the characteristics of three-dimensional shape about intracranial aneurysms and precisely provide a basis for the design of individual keyhole approach which is prerequisite for a successful surgery.