术中CT在颅内动脉瘤手术中的应用  

Application of intraoperative CT in intracranial aneurysm surgery

作　　者：彭定伟[1] 孙正辉[1] 许百男[1] 武琛[1] 步啸[1] 薛哲[1] 董天翔[2] 

机构地区：[1]解放军总医院神经外科,北京100853 [2]解放军总医院骨科,北京100853

出　　处：《解放军医学院学报》2013年第5期467-471,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨术中CT在颅内动脉瘤手术中的应用价值。方法收集本院2012年3-7月开颅手术治疗颅内动脉瘤患者20例。在动脉瘤处理前后分别行CT灌注成像(CT perfusion,PCT)及CT血管造影(CT angiography,CTA)扫描,根据两次PCT灌注参数及CTA情况指导手术操作,并将其与体感诱发电位(somatosensory evoked potential,SSEP)及微血管多普勒超声(microvascular doppler ultrasonography,MDU)等常规术中监测手段作比较。结果手术共处理动脉瘤23个,按GOS标准:好19例(95%),差1例(5%)。共行PCT扫描41次,CTA扫描20次,图像质量良好57次(93.4%),差4次(6.6%)。术中CT确认脑灌注异常1例,调整动脉瘤夹位置后恢复;CTA提示无动脉瘤残颈及载瘤动脉闭塞。2例SSEP有明显变化,3例MDU有变化。术后CT平扫均未见术区出血,2例颅内血肿者术后CT平扫提示血肿清除满意。结论术中CT可作为动脉瘤夹闭术中评价动脉瘤是否残留、载瘤动脉及穿支动脉是否狭窄或闭塞的重要检查手段。Objective To study the application of intraoperative CT in intracranial aneurysm surgery.Methods Twenty intracranial aneurysm patients who underwent craniotomy in our hospital from March to July 2012 were included in this study.Surgical procedure was decided according to the twice CT perfusion（PCT） and CT angiography（CTA） findings before and after clipping of aneurysm and compared with conventional intraoperative monitoring methods such as somatosensory evoked potential（SSEP）,microvascular Doppler ultrasonography（MDU）.Results Twenty-three aneurysms were successfully removed.The outcome was good in 19 patients（95%） and poor in 1 patient（5%） according to the GOS criteria.The quality of images including 41 PCT and 20 CTA images was good in 57 patients（93.4%） and poor in 4 patients（6.6%）.Intraoperative CT showed abnormal brain perfusion in 1 patient,which became normal after the clip was replaced.CTA showed no residual aneurysm and parental artery occlusion.SSEP was significantly abnormal in 2 patients and MDU was abnormal in 3 patients.CT scan after operation revealed no cerebral hemorrhage and satisfactory hematoma evacuation in 2 patients.Conclusion Intraoperative CT is an important means for the assessment of residual aneurysm,stenosis or occlusion of parental and perforating arteries in clipping of intracranial aneurysm.

关 键 词：颅内动脉瘤 外科手术 术中CT 

分 类 号：R743[医药卫生—神经病学与精神病学]