三维全脑血管造影联合神经内镜辅助在手术治疗颅内前循环动脉瘤中的应用价值

Value of three-dimensional digital subtraction angiography combined with neuroendoscope to the surgery for intracranial anterior circulation aneurysm

目的探讨三维全脑血管造影(3D-DSA)模拟手术联合神经内镜在颅内前循环动脉瘤外科手术中的应用价值。方法研究纳入最终经手术证实的颅内动脉瘤病例,且术前均已行3D-DSA检查明确动脉瘤位置及其与载瘤动脉的关系,并进行术前动脉瘤手术模拟。术中在显微镜下夹闭动脉瘤前后均用神经内镜观察动脉瘤蒂结构和穿通支,直视下证实动脉瘤夹的位置。术后复查3D-DSA,评估动脉瘤夹夹闭效果。结果共纳入符合要求的病例28例。术前3D-DSA均清晰地显示了动脉瘤、载瘤动脉及其与周围血管和骨结构的关系,与手术中所见基本一致,在神经内镜下可清楚观察动脉瘤周围特别是细小穿动脉的解剖走形,且内镜下可直视动脉瘤夹位于或调整后位于合适的位置,避免最终的误夹或夹闭不全。术后复查3DDSA,均显示动脉瘤夹闭满意。结论 3D-DSA术前模拟手术有助于术中迅速找到并显露动脉瘤,术中神经内镜辅助有利于保护深部血管并及时调整动脉瘤夹夹闭的位置,防止动脉瘤颈残留、载瘤动脉不畅或深部穿支血光损伤等并发症。3D-DSA术前模拟手术联合术中神经内镜辅助可有效降低手术并发症的发生率并提高手术成功率。

Objective To evaluate the value of three-dimensional digital subtraction angiography（3D-DSA） combined with neuroendoscope to the surgery for intracranial anterior circulation aneurysm. Methods Cases which were confirmed as intracranial anterior circulation aneurysm by surgery and were checked with 3D-DSA preoperatively as well as aneurysm surgery simulation were enrolled in this study. Also the 3D-DSA was used to detect the relationship between the concomitant vessel and the aneurysm before and after the surgery. The neuroendoscope was used to observe the location of the aneurysm clip. Results Total of28 patients were enrolled in this study finally. The preoperative 3D-DSA can clearly display the aneurysm and the relationship between the surrounding blood vessels and bone structure. The operation was almost can be simulated by 3D-DSA preoperatively.The neuroendoscope can assist to observe the aneurysm especial the location of the aneurysm clip clearly. The 3D-DSA confirmed the right location of the aneurysm clip. Conclusion 3D-DSA surgery simulation before surgery helps to confirm the aneurysm quickly during surgery. Nerve endoscope assisted to protect of the deep veins. 3D-DSA combined with nerve endoscope can reduce complication of the operation and improve the quality of surgery.