[3D-CTA引导下显微手术治疗颅内动脉瘤的疗效观察]颅内动脉瘤3D视频

　　[摘要] 目的 观察三维CT血管造影（3D-CTA）引导下神经内镜辅助的显微手术治疗颅内动脉瘤的疗效。 方法 选择经手术证实的颅内动脉瘤42例，术前均行3D-CTA检查并进行动脉瘤手术模拟，确定动脉瘤位置及其与载瘤动脉的关系，术中手术显微镜下夹闭动脉瘤前后，神经内镜观察动脉瘤蒂结构和穿通支，并证实动脉瘤夹的位置。 结果 术前3D-CTA能清晰地显示动脉瘤及其与周围血管和骨结构的关系，与术中所见基本一致，在内镜下可清楚观察动脉瘤周围的解剖，特别是细小穿动脉。术后复查3D-CTA，均显示动脉瘤夹闭满意。 结论 术前3D-CTA的模拟有助于确定手术入路，进行病灶的空间定位，避免不必要的损伤；结合神经内镜辅助显微手术有利于提高手术成功率，降低并发症的发生率。
　　[关键词] 颅内动脉瘤；三维CT血管造影；神经内镜；显微手术
　　[中图分类号] R743 [文献标识码] C [文章编号] 1673-7210（2012）07（c）-0150-02
　　Effects of three-dimensional computed tomograph angiography and neuroendoscope assisted microsurgery for intracranial aneurysm
　　ZHAO Zhongjiang
　　Department of Neurosurgery, the Third Hospital of Xingtai City, Hebei Province, Xingtai 054000, China
　　[Abstract] Objective To observe the effects of 3-dimensional computed tomograph angiography (3D-CTA) and neuroendoscope assisted microsurgery for intracranial aneurysm. Methods 42 patients with intracranial aneurysm were diagnosed by 3D-CTA. 3D-CTA was used to locate situations of all the leisions and its relationship with parent aneurysm artery. Endoscopy was used to observe the neck anatomic features and perforating branches and to verify the optimal clipping position before and after the microsurgical treatment. Results Pre-operative 3D-CTA clearly displayed the aneurysm and their relation with the parent aneurysm artery, the aneurysm, the periphery vessel, and bony structures, according to demonstration during the operation. Endoscope clearly showed the anatomy around aneurysm, especially the perforating branches. Postoperative 3D-CTA showed satisfactory aneurysm clipping. Conclusion 3D-CTA and neuroendoscope assisted microsurgery is helpful in finding and exposing aneurysm, can avoid not necessary injury; combing with neuroendoscope assisted microsurgery, can enhance operative successful rate, reduce complication rate.
　　[Key words] Intracranial aneurysm; Three dimensional computed tomograph angiography; Neuroendoscope; Microsurgery
　　颅内动脉瘤是常见的颅脑血管畸形，由于其起病隐匿、发病突然、预后差等特点，近年来引起临床上高度的重视。降低颅内动脉瘤病死、病残率的关键因素是及时有效地选择合适的手术治疗方法，显微外科脑动脉瘤瘤颈夹闭术是手术治疗颅内动脉瘤的主要方法[1-2]。作为微创神经外科的重要分支，神经内镜及三维CT血管造影（3D-CTA）在颅内动脉瘤显微手术中的应用，显著地提高了手术成功率[3-4]，减少误夹和夹闭不全的风险。我科2008年2月～2011年7月采用术前3D-CTA定位、神经内镜联合显微手术夹闭颅内动脉瘤42例，效果满意，现报道如下：
　　1资料与方法
　　1.1 一般资料
　　所选42例颅内动脉瘤患者中，男24例，女18例；年龄42～73岁，平均（56.4±17.5）岁。所有患者均有颅内动脉瘤破裂出血的临床表现：嗜睡18例，浅昏迷7例，中昏迷9例，深昏迷8例，Hunt-Hess分级：Ⅰ级12例，Ⅱ级18例，Ⅲ级7例，Ⅳ级3例，Ⅴ级2例。出院时进行格拉斯哥预后评分（GOS）。
　　1.2 动脉瘤数目、形态及部位
　　42例病例均经DSA确诊。单发动脉瘤38例，2个以上多发动脉瘤4例，动脉瘤总数为51个。囊状动脉瘤43个，梭形动脉瘤8个。前交通动脉瘤16例，颈内动脉C1段动脉瘤11例，颈内动脉C2段8例，大脑中动脉M2段动脉瘤15例，大脑后动脉末端分叉处动脉瘤1例。