CT血管造影指导颅内破裂动脉瘤超早期手术

目的研究单一依靠CT血管造影(CTA)资料,在超早期手术夹闭破裂颅内动脉瘤的可行性。方法从2004年6月至2007年2月,共有125例自发性蛛网膜下腔出血病人行CTA检查。其中有78例在出血后72h内完成CTA检查,并对57例患者单一依靠CTA资料急诊行超早期动脉瘤夹闭术。结果125例自发性蛛网膜下腔出血患者中,有78例在出血后72h内完成CTA检查,71例发现颅内动脉瘤,其中有57例行超早期开颅动脉瘤夹闭术。57例超早期开颅手术动脉瘤患者,多发动脉瘤4例,共61个动脉瘤,术中夹闭动脉瘤60个,动脉瘤包裹1个。CTA能很好地显示动脉瘤的大小、形态、同载瘤动脉及周边骨性结构的关系,为手术提供了足够的有用信息。结论容积重建成像CTA是一种可靠、无创的快速诊断颅内动脉瘤的方法,能为破裂动脉瘤的超早期夹闭手术提供详实的影像学资料,满足在急诊状况下开颅夹闭手术所需。

Usefulness of three-dimensional computed tomographic angiography for surgical planning in treating ruptured intracranial aneurysms

Objective To evaluate the value of 3D-CTA with volume rendering for the planning in early clipping ruptured intracranial aneurysm. Methods Since late 2004 to early 2007, our hospital has adopted a protocol of CTA as the only diagnostic and pretreatment planning study for SAH patients in emergency. Seventy-eight patients finished CTA within 72 hours of initial bleed, and 57 patients were performed aneurysm early clipping. Results During the study period, 125 SAH patients were examined with CTA, including 78 patients finished CTA within 72 hours of initial bleed and there were 61 intracranial aneurysms found in 71 patients, and there were no aneurysms in other 7 patients. Intracranial aneurysm treatment was initiated on the basis of CTA alone. Treatment consisted of early surgical clipping in 57 patients within 72 hours of initial bleed, endovascular coiling in 10 patients. Three patients did not undergo treatment. Because of the neck of aneurysm was unclear in CTA, one patient performed DSA and clipped aneurysm lately. Three-dimensional CT angiography with volume rendering well demonstrated aneurysms and provided useful information including their site, shape, size and the spatial relationship to the surrounding vessels and bony structures. Conclusion Three-dimensional CT angiography with volume rendering is a quick, reliable, and relative noninvasive diagnostic tool for intracranial aneurysms. It can delineate the aneurysmal morphology in detail, and it can provide enough information for making decisions and planning microsurgical clipping in emergency.