数字减影全脑血管造影在连头婴显微分离术前及术中的应用

Effect of digital subtract cerebral angiography on microsurgical separation of craniopagus

目的 探讨全脑血管造影在连头婴显微分离手术术前和术中的作用。 方法 术前在出生后 3个月进行股动脉入路脑血管造影 ,16个月时经股动脉和股静脉入路对双婴颈内动脉、颈外动脉、椎动脉及超选静脉窦内进行造影 ;术中行脑血管造影监测 ,判断脑血管情况。 结果 术前造影显示双婴连接部颅内动脉无交通 ,双婴上矢状窦后 1/3、窦汇、右婴的左侧横窦与左婴的右侧横窦起始部融合共用 ;术中实时脑血管造影对显微分离过程中有关静脉窦的处理进行较好的监测。 结论 全脑血管造影是了解连头婴脑血管复杂情况的最佳方法 ,尤其静脉窦内造影可以充分了解静脉窦变异相融处的解剖和血流动力学变化。术中脑血管造影在静脉窦转流和血管重建手术中有重要的指导意义及监测作用。

Objective To investigate the effect of cerebral angiography on separation of craniopagus during the period of preoperation and microsurgical operation Methods There was a case of craniopagus being separated in our hospital recently Cerebral arteriography at 3 months of life, arteriography and venography through femoral vessels at 16 months were performed to analyze the twin vascular circulations of bilateral internal carotid artery, external carotid artery, vertebral artery, and venous sinus Intraoperative cerebral angiography helps to evaluate the cerebral circulations Results Preoperative cerebral angiography showed no intracranial arterial connection in the pontes of craniopagus The posterior 1/3 part of superior sagittal sinus, partial transverse sinus and torcular herophili were confluented in two children Cerebral angiography during operation was significant for monitoring the management of the part of confluent venous sinus Conclusion Cerebral angiography is the best method to investigate the vascular conditions of craniopagus The selective sinus angiography is very important in analyzing the abnormal anatomy and hemodynamics of venous sinus in the pontes Intraoperative angiography can direct the bypass shunt and reconstruction of the sinus