一种判定颈内动脉床突旁动脉瘤位于硬膜下或海绵窦内的新方法

A new method to determine the location of paraclinoid carotid aneurysms in subdural area or cavernous sinus

目的探讨判定颈内动脉床突旁动脉瘤位于硬膜下或海绵窦内的新方法。方法回顾性分析30例颈内动脉床突旁动脉瘤病例的手术前后3D-CTA资料并与手术中动脉瘤探查结果对比研究。结果该组病人共有颅内动脉瘤44个,其中颈内动脉床突旁动脉瘤共计32个:24个动脉瘤术中证实位于硬膜下,8个位于海绵窦内。将手术观察的结果与3 D-CTA图像对比发现,前床突下缘与鞍结节的虚拟连线在3 D-CTA图像上正好标示颈内动脉床突段硬膜环的近侧环水平,24个颈内动脉硬膜下动脉瘤在该连线上方,8个海绵窦内动脉瘤在该连线下方。结论 3D-CTA图像前床突下缘与鞍结节的虚拟连线可以标示近侧硬膜环水平,能清晰界定颈内动脉床突旁动脉瘤与海绵窦的位置关系。

Objective To investigate a new method to determine the location of paraclinoid carotid aneurysms in the subdural area or cavernous sinus. Methods The clinical data of 30 patients with paraclinoid carotid aneurysms diagnosed by three-dimensional computed tomography angiography（ 3D-CTA） were retrospectively analyzed and compared with the results of intraoperative exploration. Results Among the 30 patients,there were 44 intracranial aneurysms in total,among which there were 32 paraclinoid carotid aneurysms,24 aneurysms in the subdural area,and 8 in the cavernous sinus. The comparison of the results of intraoperative exploration with 3D-CTA images showed that the virtual line between the inferior border of the anterior clinoid process and the tuberculum sellae on3D-CTA indicated the proximal dural ring of the internal carotid artery. The 24 subdural aneurysms were located above the virtual line and the 8 cavernous sinus aneurysms were located below this line. Conclusions The virtual line between the inferior border of the anterior clinoid process and the tuberculum sellae on 3D-CTA indicates the proximal dural ring of the internal carotid artery and can clearly determine the positional relationship between paraclinoid carotid aneurysms and cavernous sinus.