3D-CTA对破裂大脑中动脉瘤诊断及手术指导意义

The clinical value of three-dimensional CT angiography(3D-CTA) in the diagnosis and treatment of intracranial the rupture middle cerebral artery aneurysm

目的探讨3D-CTA对破裂大脑中动脉瘤诊断和手术指导作用。方法我院神经外科从2010年1月-2011年12月经3D-CTA对收住自发性蛛网膜下腔出血病人检查证实的122例颅内动脉瘤,其中18例为大脑中动脉动脉瘤,进行了术前CTA手术模拟。17例行翼点入路开颅显微外科手术,动脉瘤夹闭手术,与术前CTA影像学资料进行了对比。结果术前经3D-CTA诊断不同部位大脑中动脉瘤术中所见完全一致。术中除1例大脑中动脉瘤M2段梭形动脉瘤行包裹术外,其余17例动脉瘤均成功行夹闭手术。术后16例病人恢复良好痊愈出院。1例术前破裂大脑中动脉瘤病人,Hunt-Hess分级V级,术后双侧脑疝死亡。1例病人入院做术前准备时,动脉瘤二次破裂出血,急诊手术,术后病人偏瘫生活不能自理。结论术前单独依靠CTA对不同部位大脑中动脉瘤进行诊断及模拟手术,对破裂大脑中动脉瘤成功手术夹闭具有较好应用价值。

Objective To study the clinical value of three -dimensional CT angiograpliy （3D-CTA） in the diagnosis and treatment of intraeranial the ruptured middle cerebral artery aneurysm（MCAA）. Methods FromJanuary 2010 to December 2011 , a retrospective study was performed on 122 patients with spontaneous subarachnoid hemorrhage with 18 middle cerebral artery aneurysms. All the patients were examined by 3D-CTA before operation and surgical simulation was conducted. 17 middle cerebral artery aneurysms were clipped by pterional approach microsurgical surgery and compared preoperative 3D-CTA imaging data. Results Preoperative diagnosis by 3D-CTA in different location of middle cerebral artery aneurysms had seen exactly the same with intraoperation. In addition to a fusiform aneurysm of M2 middle cerebral artery was wrapped, the remaining 17 aneurysms were successful clipping. 16 patients of good recovery after operation. One patient due to preoperative Hunt - Hess scores V grade and he died of bilateral hernia after operation. One patient admitted to hospital in preparation to operate before the second hemorrhage, The patients could not be self- reliant life after emergency surgery. Conclusion 3D-CTA can diagnose and simulate surgery to different location ruptured the middle cerebral artery aneurysm. It can provide good value for successful clipping surgery of middle cerebral artery aneurysm.