颈动脉体瘤的DSA检查方法和价值

目的 探讨颈动脉体瘤术前DSA检查的方法,表现及对手术的指导作用.方法 5例颈动脉体瘤术前接受DSA检查,包括双侧颈总动脉造影,选择性颈内动脉和椎动脉造影,其中4例进行了Matas试验交叉造影.造影后5例患者均手术切除了肿瘤,其中单纯肿瘤分离切除3例,肿瘤切除加颈动脉修补1例,肿瘤连同颈动脉切除1例.结果 5例肿瘤DSA表现典型,包括颈动脉分叉角度增大,血供丰富,肿瘤部分或完全包绕颈动脉.此外1例椎动脉分支参与肿瘤供血,1例出现动-静脉瘘.颈内动脉造影1例患侧大脑前动脉水平段发育不艮.Matas试验2例Willis环代偿艮好,1例经2周训练后Willis环开放,1例因大脑前动脉水平段发育不良,无法建立有效代偿.结论 颈动脉体瘤具有典型的DSA表现,且在肿瘤对血管侵蚀程度的判断、脑血管发育状况和代偿能力、颈动脉阻断后脑耐受性的评估等方面,DSA具有不可替代的作用,可为手术风险的评估和手术方案的制定提供依据.

Methods and Values of digital subtraction angiography in carotid body tumor

Objective To investigate the methods, manifestations and values of preoperative digital subtraction angiography(DSA) in carotid body tumor(CBT). Methods Preoperative DSA were accepted in 5 cases with CBT, including bilateral common carotid artery angiography, selective internal carotid artery angiography and vertebral arteries angiography,of which 4 cases underwent cross angiography of Matas-test. All tumors were resected after angiography. The tumors were simply resected in 3 cases of them, the internal carotid artery was repaired after tumorectomy in 1 case, and the tumor, combined with carotid artery in 1 case, was resected. Results All the 5 cases with CBT exhibited typical manifestations in DSA. The DSA character of CBT showed expending of carotid artery bifurcation, ample blood perfusion, and carotid arteries encircled partially or entirely by the tumor. The branch of vertebral artery participate in tumor blood-supplying in 1 case, and arteriovenous fistula was observed in 1 case. Dysplasia of anterior cerebral artery horizontal segment was observed in 1 case by internal carotid angiography. Circle of Willis showed sufficient compensation through Matas test in 2 cases, and opened after 2 weeks training in 1 case. In one case effective compensation could not be founded because of the dysplasia of anterior cerebral artery horizontal segment. Conclusion The CBT showed characteristic manifestation in DSA. Preoperative angiography is irreplaceable for judgment to the connection between the tumor and the carotid arteries, development and compensation of cerebral arteries, and tolerance of brain tissue after carotid artery occlusion. It is helpful for the evaluation of the risk of operation and protocols.