三维CT血管造影在颅内动脉瘤夹闭手术中应用的初步经验

目的 评估三维CT血管造影（3D－CTA）在颅内动脉瘤手术中的应用价值。方法 对1997年9月至2000年4月间手术的32例脑动脉瘤病人在术前进行3D－CTA检查，并将其图像应用于手术。除4例危重患仅行3D－CTA外，其余患均同期行DSA检查。结果 除1例多发性动脉瘤因3D－CTA扫描平面确定有误而漏检1个动脉瘤外，其余的动脉瘤均被3D－CTA发现，并被手术所证实。3D－CTA均清晰显示了动脉瘤的部位、大小、形状、指向、瘤颈部位以及动脉瘤的破口，并显示了动脉瘤与截瘤动脉以及颅底骨结构的三维影像。其在显示颅内动脉瘤的形态、方向、部位与毗邻骨结构上优于DSA，有助于手术入路的设计以及术中寻找动脉瘤和载瘤动脉。结论 3D－CTA有助于颅内动脉瘤手术入路的设计以及术中寻找动脉瘤和载瘤动脉，尤其适合于床突旁动脉瘤、前交通动脉瘤，大型或巨型动脉瘤的手术以及急诊夹闭手术。

Preliminary Experience of Application of Three-dimensional CT Angiography(3D-CTA) in Microsurgical Operation of Intracranial Aneurysms

Objective To assess the value of 3D-CTA in microneurosurgical operation of intracranial aneurysms. Method Thirty-two patients with intracranial aneurysms, who admitted to our department between September 1997 and April 2000, were examined by the 3D-CTA prior to the operation. In addition, all except 4 severe patients also received DSA. Results Existence of intraeranial aneurysms was detected by the 3D-CTA in 31 of the 32 cases and subsequently verified by the operation. The 3D-CTA missed an aneurysm in a patient with multiple aneurysms due to technical error. The 3D-CTA clearly revealed the site, size, shape, direction and neck of these aneurysms as well as its bleeding site. The 3D-CTA also demonstrated the three-dimensional structure of the aneurysm, its parent artery and surrounding structures of the skull base. 3D-CTA is superior to DSA in depicting the intracranial aneurysms shape, direction, location and the surrounding bony structures. Conclusions 3D -CTA has distinct advantages both in planning of the operative approach and locating the aneurysm and parent artery intraoperatively. It is especially helpful to the neunosurgeons in dealing with paraclinoid or anterior communicating artery and large or giant aneurysms, and to emergently clipping operation.