3D-CTA引导下显微手术治疗颅内动脉瘤的疗效观察

Effects of three-dimensional computed tomograph angiography and neuroendoscope assisted microsurgery for intracranial aneurysm

目的观察三维CT血管造影(3D-CTA)引导下神经内镜辅助的显微手术治疗颅内动脉瘤的疗效。方法选择经手术证实的颅内动脉瘤42例,术前均行3D-CTA检查并进行动脉瘤手术模拟,确定动脉瘤位置及其与载瘤动脉的关系,术中手术显微镜下夹闭动脉瘤前后,神经内镜观察动脉瘤蒂结构和穿通支,并证实动脉瘤夹的位置。结果术前3D-CTA能清晰地显示动脉瘤及其与周围血管和骨结构的关系,与术中所见基本一致,在内镜下可清楚观察动脉瘤周围的解剖,特别是细小穿动脉。术后复查3D-CTA,均显示动脉瘤夹闭满意。结论术前3D-CTA的模拟有助于确定手术入路,进行病灶的空间定位,避免不必要的损伤;结合神经内镜辅助显微手术有利于提高手术成功率,降低并发症的发生率。

Objective To observe the effects of 3-dimensional computed tomograph angiography（3D-CTA） and neuroendoscope assisted microsurgery for intracranial aneurysm.Methods 42 patients with intracranial aneurysm were diagnosed by 3D-CTA.3D-CTA was used to locate situations of all the leisions and its relationship with parent aneurysm artery.Endoscopy was used to observe the neck anatomic features and perforating branches and to verify the optimal clipping position before and after the microsurgical treatment.Results Pre-operative 3D-CTA clearly displayed the aneurysm and their relation with the parent aneurysm artery,the aneurysm,the periphery vessel,and bony structures,according to demonstration during the operation.Endoscope clearly showed the anatomy around aneurysm,especially the perforating branches.Postoperative 3D-CTA showed satisfactory aneurysm clipping.Conclusion 3D-CTA and neuroendoscope assisted microsurgery is helpful in finding and exposing aneurysm,can avoid not necessary injury;combing with neuroendoscope assisted microsurgery,can enhance operative successful rate,reduce complication rate.