MSCT血管造影在颅底脑膜瘤手术入路及术式选择的应用  

Application of MSCT Angiography in Administration of the Surgical Approach and Method for Cranial Base Meningioma

作　　者：陈建强[1] 韩向君[1] 金虎[2] 李刚[2] 陈晶[1] 关莹[3] 战跃福[1] 李香营[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院放射科,海南海口570208 [2]中南大学湘雅医学院附属海口医院神经外科,海南海口570208 [3]海南医学院附属医院放射科

出　　处：《实用放射学杂志》2010年第10期1390-1392,1397,共4页Journal of Practical Radiology

基　　金：海南省自然科学基金资助项目（808246）.

摘　　要：目的 探讨多排螺旋CT血管造影（MSCTA）对颅底脑膜瘤手术入路及术式选择的应用价值.方法 对本院40例颅底脑膜瘤患者术前行MSCTA检查,利用三维重建图像模拟手术操作,以术中所见为标准对照.结果 通过MSCTA模拟操作后40例患者皆合理的设计和选择了手术入路和术式,术中所见与模拟操作所遇情况高度一致,有效地避免了颅内重要血管及神经功能区的损伤,其中MSCTA显示4例颅内重要动脉明显阻碍手术操作窗而改变了常规入路途径,6例跨区生长瘤体单纯入路由于入路远侧瘤体暴露困难而改为联合扩大术式,4例瘤体侵及视神经、脑干走行区或包裹颅内重要动脉提示全切风险大而术前早期制订了次全切手术方案及放疗计划.结论 通过MSCTA模拟手术操作对指导颅底脑膜瘤临床选择最佳手术入路及术式有重要意义.Objective To discuss the value of multi--slice spiral CT angiography （MSCTA） in guiding the surgical approach and method for cranial base meningioma. Methods Forty patients with cranial base meningioma were examined preoperatively with MSCTA. Three--dimensional images were reconstructed so that to imitate the approach and method of operation and compared with surgical findings. Results By imitating the operation＇,the surgical approaches and methods in all cases were designed and selected appropriately,intraoperative findings were consistent with the encountered of the simulated operation. The peritumoral vessels and nerve function area were kept off effectively. The conventional surgical approach was changed because of the operative windows were obviously hindered by the major intracranial arteries in 4 cases and it was difficult to exposure the distal part of the tumor in 6 cases after MSCTA, while the planning of total resection of tumor was changed as the sub--total resection and radiotherapy preoperatively in 4 cases because of the optic nerve and brain stem involved by tumors or the intracranial artery was embedded by tumors that was very dangerous for total resection after MSCT A. Conclusion Simulated surgical operation by MSCTA preoperation is of significant value in guiding the best surgical approach and methods.

关 键 词：脑 脑膜瘤 血管造影术 体层摄影术 X线计算机 

分 类 号：R739.41[医药卫生—肿瘤]