三维重建结合手术体位改变在老年脑动脉瘤介入治疗中的应用分析  

Application analysis of three dimensional reconstruction in combination with change of surgical position in elderly cerebral aneurysm interventional therapy

作　　者：李正明[1] 卜向飞[1] 刘骥[1] 金孝东[1] 丁涟沭[1] 

机构地区：[1]淮安市第一人民医院神经外科,江苏223300

出　　处：《脑与神经疾病杂志》2015年第1期35-37,共3页Journal of Brain and Nervous Diseases

摘　　要：目的研究三维重建结合手术体位改变于老年脑动脉肿瘤介入治疗中的临床疗效。方法选择30例经CT证实为蛛网膜下腔出血(SAH)的60岁以上患者做为研究对象,股动脉插管后行造影,使用数字减影血管造影(DSA)系统对患者采集的原始影像学资料进行三维重建结合,并使用advantage workstation工作站进行后期处理得到3D图像。在工作站重建处理同时,将超过DSA系统C臂机架患者使用头颅固定架保证透视图像中患者头颅为正位。结果 30例患者中15例经动脉造影可清晰显示动脉瘤,12例患者瘤体与周围血管的关系显示不甚清楚,进行三维重建,清晰显示患者动脉瘤体及其周围血管间的关系。另外3例患者DSA系统无法显示正位头颅图像,通过使用头颅固定架旋转适宜角度,可清晰显示脑动脉瘤。结论老年脑动脉瘤患者基础疾病较多,脑动脉瘤血管充盈不充分或角度投射不当,血管走行重叠等,造成手术中动脉瘤的显示不清楚,可以通过DSA检查结合血管三维重建并进行手术中体位的适当改变可以弥补因机械无法达到的体位,使具体操作更加清晰地显示瘤体与载瘤动脉间的关系,提高手术的成功率。Objective To study the clinical effects of the three dimensional reconstruction in combination with change of surgical position in elderly cerebral aneurysm interventional therapy. Methods Choose 30 patients confirmed by CT for subarachnoid hemorrhage （SAH） patients over 60 years of age as the research object. We performed anteroposterior and lateral angiography after femoral arterial cannulation, and used digital subtraction angiogra- phy （DSA） to perform the three dimensional reconstruction for the original imaging data of patients, after which the advantage workstation was used for post-processing to obtain 3D image. In addition to the reconstruction, cephalostat was used for patients beyond the C-arm of DSA to keep the head at anteroposterior position in radiofluoroscopic images.Results Of the 30 patients, 15 clearly showed aneurysm in the arteriography and 12 showed a result of aneurysm non-distinguishable from peripheral vessels. Another 3 patients didn＇t show anteroposterior head image in DSA,and clearly showed cerebral aneurysm after the cephalostat was rotated at proper angle. Conclusion Factors such as more underlying diseases in elderly cerebral aneurysm patients,insufficient angioplerosis of cerebral aneurysm or improper angle of projection, and overlap of vessels may lead to unclear display of aneurysm in surgery. DSA examination in combination with the three dimensional reconstruction of vessel and proper change of surgical position can compensate for the unreachable body position due to machinery, making specific operations more clearly show the relationship between aneurysm and parental artery and improving success rate of surgery.

关 键 词：三维重建技术 脑动脉瘤 老年患者 数字减影血管造影 体位改变 

分 类 号：R732.2[医药卫生—肿瘤]