神经导航辅助锁孔入路显微手术治疗颅内动脉远端动脉瘤  

Neuronavigation-assisted microsurgical operation via keyhole approaches for distal intracranial artery aneurysms

作　　者：戴纯刚[1] 陈爱林[1] 孙超[1] 吴涛 朱卿[1] 兰青[1] Dai Chungang;Chen Ailin;Sun Chao;Wu Tao;Zhu Qing;Lan Qing(Department of Neurosurgery,The Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215004,China)

机构地区：[1]苏州大学附属第二医院神经外科,江苏苏州215004

出　　处：《中华显微外科杂志》2019年第6期553-556,共4页Chinese Journal of Microsurgery

基　　金：国家重点研发计划(2016YFC1300700);江苏省医学重点学科建设项目(ZDXKB2016021);苏州市科技发展计划项目(2016YFC1300701);苏州市科技发展计划项目(SYS2019067)。

摘　　要：目的探讨神经导航系统在锁孔入路显微手术治疗颅内动脉远端动脉瘤(DIAA)中的价值。方法回顾性分析2013年1月至2018年12月采用锁孔入路显微手术治疗的16例DIAA的临床资料;其中大脑前动脉(ACA)远端动脉瘤10例,小脑后下动脉(PICA)远端动脉瘤3例,穿支动脉(PA)远端动脉瘤3例。手术前根据神经导航系统设计头皮切口与开颅骨窗,手术中采用神经导航系统定位直达病灶进行夹闭或切除。出院前复查脑血管造影,出院后每个月门诊随访至手术后6个月。结果手术中导航系统的系统误差为0.5-~1.0(平均0.6)mm,所有病灶均一次准确定位显露并成功处理,未发生手术中动脉瘤破裂以及神经导航系统相关性并发症。手术后脑血管造影证实动脉瘤均消失;2例患者因脑积水再次手术。手术后随访6个月,所有患者均恢复良好。结论神经导航系统可精确定位深在的颅内DIAA,有助于锁孔入路的设计,减少过度分离与盲目探查。增强头部CT无创、快捷、显影清晰,是神经导航系统可直接利用的理想的影像数据来源。Objective To investigate the value of neuronavigation system in the keyhole microsurgical operation for distal intracranial artery aneurysms(DIAA).Methods The clinical data of 16 cases with DIAA who were treated by via keyhole approaches,from January,2013 to December,2018,were analyzed retrospectively.Ten aneurysms located in anterior cerebral artery(ACA),3 in posterior inferior cerebellum artery(PICA)and 3 in perforator artery(PA).The optimal skin incision and craniotomy were designed with assistence of neuronavigation system preoperatively,and lesions were located precisely under the guidance of neuronavigation system during microsurgery before clipping or resection.Angiography was performned before discharge,and clinic followed-up was conducted monthly till 6 months after surgery.Results The systematic error of neuronavigation system ranged from 0.5 mm to 1.0 mm,with an average of 0.6 mm.All 16 aneurysms were explored and managed successfully with the guidance of neuronavigation system without aneurysm premature rupture nor neuronavigation-related complications.Absolute occlusion of all aneurysms was documented angiographically after surgery.Of all cases,2 experienced shunt procedure due to delayed hydrocephalus.During 6 months follow-up period,all 16 cases recovered well.Conclusion Neuronavigation system can precisely locate the deep-seated DIAA,contribute to the preoperative planning of microsurgery via keyhole approaches and avoid evitable injury during excessive manipulation.The noninvasive,rapid and contrast-enhanced CT images of head was an ideal data source for the neuronavigation system.

关 键 词：颅内动脉瘤 手术入路 锁孔 神经导航 显微手术 

分 类 号：R65[医药卫生—外科学]