文章摘要
蔡 宁,林 超,王彬彬,刘 宁.颅脑3D⁃CTA术前规划指导手术夹闭颅内动脉瘤的疗效研究[J].南京医科大学学报,2020,(12):1784~1790
颅脑3D⁃CTA术前规划指导手术夹闭颅内动脉瘤的疗效研究
Curative effects of 3D ⁃ CTA virtual imaging guided by preoperative planning in microsurgical clipping of intracranial aneurysm
投稿时间:2020-07-13  
DOI:10.7655/NYDXBNS20201208
中文关键词: 颅内动脉瘤  三维CT血管造影  显微手术  慢性硬膜下血肿
英文关键词: intracranial aneurysm  three⁃dimensional CT angiography  microsurgery  chronic subdural hematoma
基金项目:镇江市重点研发计划——社会发展(SH2019030)
作者单位
蔡 宁 江苏大学附属医院神经外科江苏 镇江 212000 
林 超 南京医科大学第一附属医院神经外科江苏 南京 210029 
王彬彬 南京医科大学第一附属医院神经外科江苏 南京 210029 
刘 宁 南京医科大学第一附属医院神经外科江苏 南京 210029 
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中文摘要:
      目的:探讨颅脑三维CT血管造影(3D?CTA)术前规划指导手术夹闭颅内动脉瘤(IA)的疗效。方法:回顾性分析采用手术夹闭治疗的198例IA患者的临床资料,根据术前3D?CTA规划手术入路、骨窗位置及大小,并与三维数字剪影血管造影(DSA)对照。术后出院时采用格拉斯哥预后评分(GOS)评价近期预后,随访统计慢性硬膜下血肿(CSDH)发生情况。结果:198例患者共计223个动脉瘤,经3D?CTA共发现220个动脉瘤,漏诊后交通动脉瘤3个,与术中探查符合率为99.55%,与3D?DSA检查结果的符合率为98.65%。198例中,192例根据术前3D?CTA规划方案成功手术,且术前成像与术中所见基本相符,6例(3.03%)因伴较大颅内血肿未按术前规划手术。预后良好率69.19%,病死率4.55%,随访CSDH发生率为5.29%。Logistic回归分析显示,未破裂IA(UIA)、蛛网膜下出血(SAH)2~3级、病灶CT值≥40 HU、术后即刻硬膜下积液(SDFC)直径≥5 mm 及术后7 d SDFC体积≥15 mL是术后发生CSDH的独立危险因素(P < 0.05)。结论:颅脑3D?CTA成像可获得立体三维模型成像,辅助动脉瘤定位及毗邻解剖关系显示,减少夹闭手术中损伤并可能降低术后CSDH发生风险。
英文摘要:
      Objective:This study aims to investigate the effect of three?dimensional computed tomographic angiograph(3D?CTA)virtual imaging guided the preoperative planning in microsurgical clipping of intracranial aneurysm(IA). Methods:The clinical data of 198 patients with IA who underwent microsurgical clipping were retrospectively analyzed. All patients received 3D?CTA virtual imaging guided the preoperative planning for the surgical approach,bone window position and size,and compared with three?dimensional digital silhouette angiography(3D?DSA). The short?term efficacy was evaluated by Glasgow Outcome Scale(GOS),incidence of postoperative chronic subdural hematoma(CSDH) was counted. Results:There were total of 223 aneurysms in 198 patients. 220 aneurysms were found by 3D?CTA,and 3 traffic aneurysms were missed,the coincidence rate with intraoperative detection was 99.55%,and the coincidence rate with 3D?DSA results was 98.65%. Total 192 patients were surgically clamped according to the preoperative planning,and the preoperative 3D?CTA imaging was basically consistent with the intraoperative findings,6 patients(3.03%)were not scheduled for surgery with large intracranial hematoma. The postoperative good prognosis rate was 69.19%,the mortality rate was 4.55%,and the incidence of CSDH was 5.29% during follow?up. Logistic regression analysis showed that the unruptured IA(UIA),subarachnoid hemorrhage(SAH)2~3 grade,CT value of lesions ≥40 HU,the subdural fluid collection(SDFC)diameter ≥5 mm and the SDFC volume ≥15 mL at 7 th day after surgery were independent risk factors for postoperative CSDH(P < 0.05). Conclusion:3D?CTA imaging can obtain stereoscopic 3D model imaging,which can assist in the positioning of aneurysms and adjacent anatomical relationships,reduce the damage during clipping surgery and may reduce the risk of postoperative CSDH.
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