荧光素钠血管造影在颅内动脉瘤夹闭手术治疗中的应用分析  

Application analysis of fluorescein sodium angiography in surgical clipping of intracranial aneurysm

作　　者：万定[1] 冯进[1] 黄德俊[1] 杨振兴[1] 孙涛[1] Wan Ding;Feng Jin;Huang Dejun;Yang Zhenxing;Sun Tao(Department of Neurosurgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院神经外科,银川750004

出　　处：《中华神经外科杂志》2022年第12期1199-1203,共5页Chinese Journal of Neurosurgery

基　　金：宁夏回族自治区重点研发计划项目(2018YBZD0034)。

摘　　要：目的探讨实时荧光素钠血管造影在颅内动脉瘤夹闭手术中应用的安全性和有效性.方法回顾性分析2020年5月至2021年12月于宁夏医科大学总医院神经外科行手术夹闭的60例颅内动脉瘤患者的临床资料.60例患者共63个动脉瘤(60个破裂,3例合并多发未破裂动脉瘤),均为前循环动脉瘤.患者常规行改良翼点或扩大翼点入路开颅,动脉瘤夹闭术中实时应用荧光素钠血管造影评估动脉瘤的夹闭情况以及载瘤动脉和穿支动脉的通畅情况,根据造影结果决定是否调整动脉瘤夹.术后复查头颅CTA评估动脉瘤的夹闭情况.采用改良Rankin量表评分(mRS)评估患者的预后.结果63个动脉瘤均成功夹闭.术中荧光素钠血管造影证实,60个(95.2%)动脉瘤一次性夹闭完全,动脉瘤囊未见显影,且载瘤动脉及穿支动脉显影良好;1个(1.6%)动脉瘤囊内有明显的黄绿色荧光显影,考虑为动脉瘤夹闭不全,予以阻断载瘤动脉后重新夹闭;1个(1.6%)动脉瘤存在瘤颈残留,给予补充夹闭;1个(1.6%)动脉瘤存在分支动脉误夹,予重新调整动脉瘤夹,患者术后未发生缺血性事件.60例患者的随访时间为(5.4±1.1)个月(3~24个月),预后良好(mRS 0~2分)54例(90.0%),预后不良(mRS 3~5分)6例(10.0%).术后3~24个月,60例患者均行头颅CTA复查,未见动脉瘤复发.结论术中实时荧光素钠血管造影可评估动脉瘤的夹闭情况,有助于及时调整手术方案和确保安全、有效地完成颅内动脉瘤夹闭术.Objective To investigate the safety and efficacy of real-time fluorescein sodium angiography in surgical clipping of intracranial aneurysm.MethodsThe clinical data of 60 patients with intracranial aneurysms who underwent surgical clipping at the Neurosurgery Department of General Hospital of Ningxia Medical University from May 2020 to December 2021 were retrospectively analyzed.There were 63 aneurysms in 60 patients(60 ruptured and 3 with multiple unruptured aneurysms),all of which were anterior circulation aneurysms.The patients underwent routine craniotomy through modified pterional or expanded pterional approach,and fluorescein sodium angiography was used in real-time during aneurysm clipping to evaluate the clipping of aneurysm and the patency of parent artery and perforating artery.Based on the angiography,whether to adjust the aneurysm clip was determined.Postoperatively,cranial CTA was performed to evaluate the clipping of the aneurysm.The patient's outcome was assessed using the modified Rankin scale(mRS).Results All 63 aneurysms were successfully clipped.Intraoperative fluorescein sodium angiography confirmed that 60(95.2%)aneurysms were clipped completely at one time,the aneurysm sac was not visualized,and the parent artery and perforating artery were well visualized;1(1.6%)aneurysm sac was visualized.There was obvious yllow-green fluorescence in the aneurysm,which was considered as incomplete clipping of the aneurysm,and the parent artery was blocked and then re-clipped;1(1.6%)aneurysm had residual aneurysm neck,and supplementary clipping was performed;1(1.6%)case reported mis-clipping of the branch artery,the aneurysm clip was readjusted,and no ischemic events occurred after the operation.The follow-up time of 60 patients was 5.4±1.1 months(3-24 months),54 patients(90.0%)had favorable outcomes(mRS:0-2 points),and 6 patients(10.0%)had poor outcomes(mRS:3-5 points).From 3 to 24 months after operation,60 patients underwent re-examination of cranial CTA,and no aneurysm recurrence was found.ConclusionsInt

关 键 词：颅内动脉瘤 神经外科手术 荧光素血管造影术 治疗结果 

分 类 号：R651.12[医药卫生—外科学]