CTA在非高血压自发性脑内血肿急诊手术中的指导作用

目的 探讨头颅多层螺旋CT血管造影(CT angiography,CTA)检查在非高血压自发性脑内血肿急诊显微外科手术治疗中的应用价值.方法 对27例需行急诊手术血肿清除的非高血压自发性脑内血肿患者,术前行头颅CTA检查,根据CTA检查结果做急诊开颅显微外科手术治疗,并对CTA在手术中的指导作用进行分析.结果 27例头颅CTA检查中,动脉瘤6例,动静脉畸形14例,烟雾病3例,无明显血管异常4例.术中探查发现动脉瘤6例,均予瘤颈夹闭;动静脉畸形14例,其中全切除12例,部分切除2例;烟雾病3例,均单纯血肿清除;海绵状血管瘤3例,均全切除;无明显原发病变1例,单纯血肿清除.术后均行头颅DSA检查,动静脉畸形残留2例,予伽玛刀治疗,烟雾病3例,无明显血管异常22例.格拉斯哥预后评分(GOS):Ⅰ级8例,Ⅱ级14例,Ⅲ～Ⅳ级5例.随访0.5-2年无再出血.结论 头颅CTA能简便、快速、无创地明确非高血压自发性脑内血肿患者中的动脉瘤、动静脉畸形、烟雾病等病因,提供直观的三维形态及解剖定位,有利于一期手术清除血肿及消除病因,降低手术风险,对非高血压性自发性脑内血肿的急诊显微外科手术治疗具有重要的指导作用.

Application of CT angiography in emergency microsurgery of spontaneous intracerebral hemorrhage without hypertension

Objective To study the application of CT angiography in emergency microsurgery of spontaneous intracerebral hemorrhage without hypertension.Method 27 patients with non-hypertensive sDontaneous intracerebral hematoma who need to acutely remove the hematoma were examined by CT angiography(CTA).Emergency microsurgery was performed according to the result of CTA,and the role of CTA in operation was analyzed.Results CTA showed intracerebral aneurysm in 6 cases,arteriovenous malformation in 14 cases.moyamoya disease in 3 cases and normal in 4 cases in our series.Six intracerebral aneurysm(all were clipped),14 arteriovenous malformation(12 cases were completely ablated,2 case were ablated partly),3 moyamoya disease(only remove the hematomal),3 cavernous angiomas(all were completely ablated)and 1 normal case(only remove the hematomal)were confirmed during microsurgery.DSA was performed after operation and showed residual arteriovenous malformation in 2 cases,moyamoya disease in 3 cases and normal condition in 22 cases.According to GOS,8 cases were graded Ⅰ,14 cases were graded Ⅱ and 5 cases were graded Ⅲ～Ⅳ.All patients were followed up for 0.5-2 years and there was not re-hemorrhage.Conclusions CTA is recommended as a reliable,rapid,noninvasive diagnostic method and can identify etiology of non-hypertensive spontaneous intracerebral hematoma.CTA can provide macroscopic three dimensions morphous and anatomic location,degrade the difficulty of the operation and play an important role in emergency microsurgery with those cases.