判断颅内多发动脉瘤出血责任动脉瘤的新方法

A new method to confirm the aneurysm responsible for hemorrhage in patients with multiple intracranial aneurysms after subarachnoid hemorrhage

目的探讨3D-DSA/CT三维影像融技术在颅内多发动脉瘤破裂后判断出血责任动脉瘤中的临床应用价值。方法2016年1月至2021年1月收治10例颅内多发动脉瘤破裂出血,将10例病人出血后6 h内首次头颅CT与3D-DSA的数据经Di⁃com接口输入Siemens System Syngo X-WP工作站进行CT/3D-DSA影像融合,获得CT/3D-DSA融合影像。根据融合影像判断出血责任动脉瘤,并制定治疗方案。结果10例中,开颅夹闭术治疗3例,支架辅助弹簧圈栓塞5例,单纯弹簧圈栓塞2例。一期成功处理责任动脉瘤后,二期行开颅夹闭术或弹簧圈栓塞治疗非责任动脉瘤。10例术后3~6个月DSA、CTA随访,动脉瘤均无复发,载瘤动脉通畅无狭窄。结论3D-DSA/CT三维影像融技术对判断颅内多发动脉瘤破裂出血责任动脉瘤具有客观、精准价值,具有科学性、开创性与实用性。

Objective To explore the clinical value of 3D-DSA/CT three-dimensional image fusion technique in confirming the aneurysm responsible for hemorrhage in the patients with multiple intracranial aneurysm(MIA)after subarachnoid hemorrhage(SAH).Methods The first head CT within 6 hours after hemorrhage and 3D-DSA data of 10 patients with MIA who were admitted to our hospital from January 2016 to January 2021 were input into the Siemens System Syngo X-WP workstation via Dicom interface to obtain the CT/3D-DSA fusion images.The aneurysms responsible for hemorrhage were confirmed and the treatment plans were made according to the fusion images.Results Of these 10 patients,3 patients were treated with microsurgical clipping,5 with stent-assisted coiling,and 2 with embolization by simple coils.After successfully treating the responsible aneurysms in the first-stage operation,the nonresponsible aneurysms were treated in in the second-stage operation by clipping or embolization.The DSA and CTA follow-up(3~6 months)outcomes showed no aneurysm recurrence and the parent artery patency without stenosis in all the patients.Conclusions The 3D-DSA/CT three-dimensional imaging fusion technique has objective and accurate value in confirming the aneurysm responsible for hemorrhage in the patients with MIA after SAH,which is scientific,innovative and practical.