术前三维DSA模拟对翼点入路夹闭前交通动脉动脉瘤侧别选择的意义  

Value of three-dimensional DSA simulation for the side selection of pterional approach to clip anterior communicating artery aneurysms

作　　者：陈虎 张涛 于嘉 罗国强 刘宇峰 邓剑平 Chen Hu;Zhang Tao;Yu Jia;Luo Guoqiang;Liu Yufeng;Deng Jianping(Department of Neurosurgery,The Second Hospital Affiliated to Air Force Medical University(The Fourth Military Medical University),Xi′an 710038,China)

机构地区：[1]解放军空军军医大学(第四军医大学)第二附属医院神经外科,西安710038

出　　处：《中国脑血管病杂志》2020年第5期246-251,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨通过术前三维DSA模拟术中观察角度选择翼点入路侧别夹闭前交通动脉动脉瘤的安全性及有效性。方法回顾性连续纳入75例翼点入路夹闭的Hunt-HessⅢ级及以下单发前交通动脉动脉瘤患者,术前通过三维DSA模拟术中观察角度,选择利于暴露侧手术;收集所有患者性别、年龄、Hunt-Hess分级、动脉瘤大小、手术侧别选择情况、并发症发生情况、术后住院时间、动脉瘤完全夹闭比例及出院时格拉斯哥预后量表(GOS)评分;比较左右侧及血管造影时不同A1优势侧入路动脉瘤夹闭情况及临床预后。结果 (1)左侧A1优势患者56例(74.7%),采用左侧翼点入路夹闭30例,右侧翼点入路夹闭26例;右侧A1优势患者19例(25.3%),采用右侧翼点入路夹闭15例,左侧翼点入路夹闭4例。(2)术中动脉瘤暴露满意,与术前三维DSA影像模拟情况相符;患者术后中位住院时间9(8,11)d;6例(8.0%)术后出现症状性脑梗死,1例(1.3%)并发颅内感染;65例术后复查头部DSA或CT血管成像,完全夹闭62例(95.4%),瘤颈处有残余3例(4.6%);出院时GOS评分5分69例(92.0%),4分3例(4.0%),3分3例(4.0%)。(3)左右侧及是否A1优势侧入路,患者手术并发症、动脉瘤完全夹闭比例、术后住院时间、出院时GOS评分等方面差异均无统计学意义(均P>0.05)。结论通过术前三维DSA模拟术中观察角度,选择利于暴露侧行翼点入路夹闭前交通动脉动脉瘤具有较高的安全性和有效性。Objective To evaluate the safety and efficiency of the treatment strategy based on three-dimensional digital subtraction angioplasty(3 D-DSA) for the side selection of pterional approach to clip anterior communicating artery aneurysm. Methods All 75 continuous patients with single anterior communicating artery aneurysm(Hunt-Hess 0-Ⅲgrade)treated by microsurgical clipping via the pterional approach were analyzed retrospectively. The side selection of approach was based on 3 D-DSA. All patients′ gender, age, Hunt-Hess grade, aneurysm size, the side of approach, complications, the length of postoperative stay, the ratio of complete occlusion, and the Glasgow outcome scale(GOS) score at discharge were collected. The ratio of complete occlusion and clinical outcome were analyzed according to the group of left or right approach and different A1 dominant approach. Results(1) Fifty-six patients(74.7%) were left A1 dominants, with 30 of those treated via the left-side approach and 26 of those treated via the right-side approach. Nineteen patients(25.3%) were right A1 dominants, with 15 of those treated via the right-side approach and 4 of those treated via the left-side approach.(2) Surgical exposure of all aneurysms was satisfactory during operation, which was consistent with the 3 D-DSA image simulation before the operation. The median length of postoperative stay was 9(8, 11)days. Six patients(8.0%) suffered symptomatic cerebral infarction, and 1 patient(1.3%) had an intracranial infection. Sixty-five cases performed DSA or CT angilgraphy after the operation. Sixty-two aneurysms(95.4%) were completely clipped and 3 aneurysms(4.6%) existed residual segments in the neck of the aneurysm. Sixty-nine patients(92.0%) reached 5 grade of GOS, 3 patients(4.0%) reached 4 grade of GOS, 3 patients(4.0%) reached 3 grade of GOS, and no patient was below 3 grade of GOS at discharge.(3) The surgical-related complications, clipping results, hospital-stay time after operation, and GOS at discharge were insignificantly different betw

关 键 词：三维数字减影血管造影 模拟 动脉瘤 前交通动脉动脉瘤 翼点入路 侧别 

分 类 号：R651.12[医药卫生—外科学]