应用3D-CTA和颅骨三维重建术精确夹闭大脑中动脉分叉部动脉瘤

Application of three-dimensional CT angiography and skull reconstruction for clipping middle cerebral artery bifurcation aneurysms

摘要:

目的 探讨应用3D-CTA和颅骨三维重建技术精确定位外侧裂开放位置及入路角度,夹闭大脑中动脉分叉部动脉瘤。方法 回顾性分析23例大脑中动脉分叉部动脉瘤患者的临床资料,其中男10例,女13例,平均年龄52岁。术前均行3D-CTA和颅骨三维重建,将蝶骨嵴向颅中窝转折处作为骨性标记,参照该骨性标记确定动脉瘤位置,确定开放外侧裂位置及入路方向,进行分离外侧裂夹闭动脉瘤。结果 23例大脑中动脉瘤患者,在开放外侧裂长度1.5~2.0 cm,以45度方向,分离外侧裂深度大约1.5 cm处顺利暴露动脉瘤、M1分叉部及M1末端,均被顺利夹闭,术后有复查头颅CTA,动脉瘤均消失,载瘤动脉通畅,术后1个月随访,患者GOS评分均在4分以上。结论 应用3D-CTA和颅骨三维重建技术,精确定位外侧裂开放位置及入路的角度,可以小范围开放外侧裂夹闭大脑中动脉分叉部动脉瘤,获得良好效果。

Abstract:

Objective To discuss the application of three-dimensional CT angiography (3D-CTA) and skull reconstruction in determination of the precise location of the lateral fissure and entry angle, and to clip middle cerebral artery bifurcation aneurysms.Methods The clinical data of 23 patients with middle cerebral artery bifurcation aneurysms were retrospectively analyzed. These patients consisted of 10 males and 13 females, with a mean age of 52 years. Preoperative 3D-CTA and skull reconstruction were performed for all patients. The bony marker was set at the turning point of the sphenoid ridge towards the middle cranial fossa. The lateral fissure was separated and the aneurysm was clipped after determination of the precise location of the aneurysm, lateral fissure, and entry angle referring to the bony marker.Results In the 23 patients with cerebral aneurysms, the aneurysms, M1 bifurcations, and M1 ends were successfully exposed with a lateral fissure length of 1.5~2.0 cm, an entry angle of 45 degrees, and a lateral fissure depth around 1.5 cm. The aneurysms in all patients were successfully clipped. The reexamination of the skull by CTA after surgery showed that all aneurysms disappeared and the artery with aneurysm was clear. The postoperative one-month follow-up revealed Glasgow Outcome Scale scores above 4 in all patients.Conclusions Determination of the precise location of the lateral fissure and entry angle using 3D-CTA and skull reconstruction can help to clip the middle cerebral artery bifurcation aneurysms with a small lateral fissure and achieve satisfactory treatment outcomes.