运用CT断层解剖图像对基底节区出血手术入路进行个性化设计

Individually Design approach in cases of basal ganglia hemorrhage by using CT sectional anatomy images

目的:用影像断层解剖图像分析比较基底节区血肿与各解剖结构的距离关系及侧裂宽度,探讨手术入路的选择方法。方法:回顾性统计分析58例患者的CT图像上血肿与各解剖结构的距离关系以及各病例侧裂发育情况。结果:血肿与岛环沟下颞干关系最恒定,占所有病例数的77.59%,其次,血肿与岛域表面相近也占相当的比重,达63.79%,侧裂宽度大于0.25cm占74.14%。再次,25.86%病例血肿沿钩状束延伸接近额下回皮层。最后,所有病例中延伸到靠近额中回皮层及缘上回皮层的均占10.34%。结论:经颞干基底节区血肿清除术作为基本的手术方法能应用于较多的病例,而各病例由于血肿形态和延伸方向的不同,往往有不止一种手术入路选择,有时往往需结合几种手术入路进行血肿清除。当侧裂蛛网膜下入路和皮层颞干入路均适合时,制定手术方案时应个体化考虑,结合患者的侧裂蛛网膜间隙情况及年龄、术者对基底节区血肿相关各解剖结构的熟悉程度等因素进行综合评估。

Objective：the distances from basal ganglia hemorrhages to different anatomic structures of the brain were compared and sylvian fissure width was analyzed,by using CT Sectional anatomy images,with the aim at selecting a individualized surgical approach in basal ganglia hemorrhage. Methods：the CT images of 58 basal ganglia hemorrhage cases were retrospectively analyzed. Results：firstly,the relationship from basal ganglia hemorrhage to temporal stem under the insula circular sulcus was most constant, with a ratio of 77.59%. secondly,short distance from hemorrhage to insula limen also had a high ratio of 63.79%,and cases with a width of sylvian fissure greater than 0.25cm had a radio of 74.14%. Thirdly,25.86% of all cases, hemorrhages extended along the uncinate fascicle. Finally,hemorrhages with a short distance to the middle frontal gyrus or to the supramarginal gyrus had a same ratio of 10.34%. Conclusion：the insula limen approach is the most basic method in surgery of basal ganglia hemorrhage,and can be used in many cases. However,each case usually had more than one approach that could be selected,because of its shape and extending direction. and sometimes,different approaches should be combined in operation. When sylvian fissure subarachnoid approach and temporal stem approach were all appropriated,the plan of the operation should be made individually,by considering elements including the sylvian fissure,age,the familiarity of the operator with the anatomic structures correlative to basal ganglia hemorrhage.