模拟翼点入路手术体位的三维DSA对颅内动脉瘤手术的指导作用

目的探讨翼点入路手术体位的三维数字减影血管造影（三维DSA）对颅内动脉瘤夹闭手术的指导意义。方法选择动脉瘤性蛛网膜下腔出血患者150例，常规血管造影发现动脉瘤后，行三维血管造影，然后将图像旋转成翼点入路手术体位的三维DSA。将影像所显示的动脉瘤的大小、空间位置、动脉瘤瘤颈、动脉瘤与载瘤动脉间的关系等，与手术中所暴露的情况进行比较。结果①三维DSA显示动脉瘤的直径与术中测量相符合的有140例，符合率为93．3％（140／150）；动脉瘤与载瘤动脉的空间位置符合率为100％。②术前根据三维DSA，共选择动脉瘤夹149枚，因与术前判断不符术中更换6枚；准确率为96．0％（143／149）。③术前有49例根据三维DSA，识别出相关穿支动脉或动脉瘤的邻近血管分支，术中发现有11例患者的重要穿支动脉被遗漏；符合率为81．7％。这些动脉均在术中解剖分离动脉瘤颈时直视下给予完整保留。结论模拟翼点入路手术体位的三维DSA能够在术前较准确地提供动脉瘤局部血管的完整信息，对手术夹闭颅内动脉瘤具有很好的指导作用。

Application of pterional approach head positional three-dimensional digital subtraction angiography in intracranial aneurysm surgery

Objective To investigate the guiding significance of pterional approach head positional threedimensional digital subtraction angiography （3D-DSA） in intracranial aneurysm clipping. Methods One hundred fifty patients with aneurysmal subarachnoid hemorrhage were enrolled in the study. Three-dimentional angiography was pertbrmed after detecting the aneurysms with conventional angiography, and then, the images of 3D-DSA were rotated to the head position for the pterional approach. The size of aneurysm, spatial location, aneurysm neck, and the relationship between aneurysm and patent artery revealed by the images were compared to the conditions at surgical exposure through pterional approach. Results Of the 150 patients, the diameter of aneurysm revealed by 3D-DSA in 140 patients were in accordance with the intraoperative measurements, the coincidence rate was 93.3% ; the coincidence rate of the spatial location between the aneurysms and its parent arteries was 100%. A total of 149 aneurysm clips were selected before the surgery according to 3D-DSA. Six clips were replaced during the operation because it was inconsistence with the prediction before the surgery, and the accurate rate was 96. 0% （143/149）. The related perforating arteries or adjacent vascular branches of anemysms in 49 patients were identified before the surgery according to 3D-DSA. The major adjacent blood vessels missed by 3D-DSA in 11 patients were detected during the surgery, and the coincidence rate reached 81.7%. These vessels were all completely preserved during intraoperative anatomical separation under the direct vision. Conclusion Head positional 3-D DSA for simulate pterional approach may accurately provide information of local blood vessels of aneurysm before surgery, and it plays a good guiding role for surgical clipping of aneurysms.