中枢神经系统疾病椎动脉V3段危险解剖变异及功能变异:附834例分析

The retrospective analysis of dangerous anatomical and functional variations of V3 segment of vertebral artery in 834 patients with central nervous system diseases

目的 回顾分析椎动脉在颅颈交界区(V3段)危险解剖变异和功能变异发生率。方法收集2019年1月至2020年10月在山东省济宁市第一人民医院行DSA及3D-DSA检查的834例中枢神经系统疾病患者影像学资料,分析永存第一节间椎动脉、椎动脉开窗、低位起源小脑后下动脉,以及优势椎动脉、终末于小脑后下动脉的椎动脉V3段危险解剖变异和功能变异发生率。结果 椎动脉V3段危险解剖变异发生率为5.52%(46/834),单侧永存第一节间椎动脉占1.92%(16/834)、单侧稚动脉开窗占1.80%(15/834)、单侧低位起源小脑后下动脉占1.68%(14/834);双侧椎动脉V3段危险解剖变异占0.12%(1/834,为一侧椎动脉开窗合并对侧永存第一节间椎动脉)。椎动脉V3段危险功能变异发生率为16.91%(141/834),优势椎动脉占13.19%(110/834),以左侧优势椎动脉更常见,共87例(79.09%,87/110),右侧优势椎动脉23例(20.91%,23/110);终末于小脑后下动脉的椎动脉31例占3.72%(31/834),右侧26例(83.87%,26/31)、左侧5例(16.13%,5/31)。结论 椎动脉V3段危险变异发生率较高,建议行颅颈交界区手术的患者术前常规行影像学检查,以筛查椎动脉危险解剖变异或功能变异病例,从而降低术中椎动脉损伤风险。

Objective To study the dangerous variations of vertebral artery(VA) at craniovertebral junction(V3 segment).Methods The imaging data of 834 patients who underwent DSA in Jining No.1 People’s Hospital from January 2019 to October 2020 were collected,the incidences of dangerous anatomical variation and dangerous functional variation of persistent first intersegmental artery,VA fenestration,posterior inferior cerebellar artery(PICA) with lower origin,dominant VA and terminating PICA were analyzed.Results The variation of V3 segment of VA was divided into dangcerous anatomical variation and dangerous functional variation.Dangerous anatomic variation included persistent first intersegmental vertebral artery,VA fenestration and PICA with lower origin.The incidence of the three types of unilateral dangerous anatomical variation was 1.92%(17/834),1.80%(16/834) and 1.68(15/834).The incidence of bilateral dangerous anatomical variation was 0.12%(1/834),while one side of the VA was fenestrated and the other side was the persistent first intersegmental artery.Dangerous functional variation included dominant VA and terminating PICA.The incidence of these two functional variation was 13.19%(110/834) and 3.72%(31/834).The left dominant VA was more common(79.09%,87/110), while the right was 23 cases(20.91%,23/110).Thirty-one cases(3.72%,31/834) of terminating PICA,while 26 cases(83.87%,26/31) in the right and 5 cases(16.13%,5/31) in the left.Conclusions The incidence of dangerous variation in V3 segment of VA is high.Imaging dangerous anatomical variation and dangerous functional variation should be routinely performed before craniovertebral junction surgery to evaluate the possible VA examinations variation patients,so as to reduce the risk of VA injury during surgery.