数字减影血管造影结合容积再现技术在颅内动脉瘤夹闭术中的应用价值

发布时间：2018-03-05 08:31

本文选题：颅内动脉瘤　切入点：蛛网膜下腔出血　出处：《中国脑血管病杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的探讨颅内动脉瘤夹闭术中DSA结合容积再现技术(VRT)的应用价值。方法回顾性连续纳入2016年1月至7月入住江苏省苏北人民医院神经外科的颅内动脉瘤患者19例,均行开颅夹闭术。夹闭后即刻行DSA并利用VRT处理相关图像,对夹闭效果欠佳者调整动脉瘤夹后,直至造影证实夹闭满意。将动脉瘤无复发且格拉斯哥预后评分为4~5分评价为治疗效果良好。结果 19例患者共计26个动脉瘤,显微镜下观察均完全夹闭。经造影证实,18个动脉瘤首次完全夹闭,1个基底动脉顶端动脉瘤其对侧大脑后动脉夹闭并伴有瘤颈残留,1个前交通动脉动脉瘤将对侧A2夹闭,1个后交通动脉动脉瘤将脉络膜前动脉完全夹闭,3个瘤颈部残留,1个大脑中动脉分叉处动脉瘤夹闭后上干血管狭窄,1个前交通动脉动脉瘤夹闭后前交通动脉及对侧A2起始处狭窄。2个因术中动脉瘤破裂出血未能调整外,其余经调整后夹闭理想。2例严重脑血管痉挛中,1例经导管缓慢注射罂粟碱后好转,1例应用罂粟碱脑棉片局部湿敷后好转。术中DSA及VRT图像处理时间30~100 min,未发生造影相关并发症。术后随访3~16个月,CT血管成像示均无动脉瘤再生长及狭窄血管闭塞,1例偏瘫,18例恢复良好。结论术中DSA结合VRT有助于术中实时观察夹闭效果、调整动脉瘤夹,可减少瘤颈残留、载瘤动脉和瘤周血管闭塞,从而改善手术效果。
[Abstract]:Objective to evaluate the value of DSA combined with volume rendering technique in intracranial aneurysm clipping. Methods 19 patients with intracranial aneurysms admitted to the neurosurgery department of Subei people's Hospital of Jiangsu Province from January 2016 to July were included retrospectively. All patients underwent craniotomy and clipping. DSA was performed immediately after clipping and related images were processed by VRT. No recurrence of aneurysms and Glasgow prognostic score of 4 ~ 5 were evaluated as good results. Results there were 26 aneurysms in 19 patients. Under microscope, 18 aneurysms were completely clipped for the first time, 1 aneurysm at the top of the basilar artery was clipped by the contralateral posterior cerebral artery with residual aneurysm neck, and 1 aneurysm of the anterior communicating artery was found to have a contralateral A2. Clipping: 1 posterior communicating artery aneurysm completely clipped anterior choroidal artery, 3 aneurysms remained in neck, 1 aneurysm of middle cerebral artery was clipped with superior trunk stenosis, 1 aneurysm of anterior communicating artery was clipped by aneurysm of anterior communicating artery, and then anterior communicating artery was clipped. And stenosis at the beginning of contralateral A2. 2 of them failed to adjust due to ruptured aneurysm bleeding during operation. Of the remaining 2 cases of severe cerebral vasospasm, 1 case was improved after slow injection of papaverine through catheter and 1 case was improved after local wet compress with papaverine Naomian tablet. The processing time of DSA and VRT images during operation was 30 minutes and 100 minutes. After 3 ~ 16 months follow-up, CT angiography showed that no aneurysm regrowth and 1 case of hemiplegia recovered well. Conclusion Intraoperative DSA combined with VRT is helpful to observe the clamping effect in real time. Adjusting the aneurysm clip can reduce the residual of the aneurysm neck, the aneurysm carrier artery and the peri-aneurysm vessel occlusion, thus improving the surgical effect.
【作者单位】：江苏省苏北人民医院神经外科;
【分类号】：R651.1

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