多辅助手段在脉络膜前动脉动脉瘤显微外科夹闭术的应用  

Application of multiple auxiliary techniques in microsurgical clipping of anterior choroidal artery aneurysms

作　　者：曾永亲 史涛 刘妲 张旭标 陈志杰 郭东亮 邓斌 王东 王国良 林涛 Zeng Yongqin;Shi Tao;Liu Da;Zhang Xubiao;Chen Zhijie;Guo Dongliang;Deng Bin;Wang Dong;Wang Guoliang;Lin Tao(Department of Neurosurgery,Guangdong Sanjiu Brain Hospital,Guangzhou,Guangdong 510080,China)

机构地区：[1]广东三九脑科医院神经外科,广东广州510080

出　　处：《中国微侵袭神经外科杂志》2024年第7期414-419,共6页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨多辅助手段在脉络膜前动脉(anterior choroidal artery,AChA)动脉瘤显微外科夹闭术的应用,以期提高AChA动脉瘤夹闭成功率,减少动脉瘤瘤颈残留及缺血性脑卒中发生率。方法回顾性分析收治18例AChA动脉瘤患者病例资料,术前存在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)14例,均采用开颅显微外科手术夹闭(占同期手术夹闭动脉瘤约4.4%)。术前所有AChA动脉瘤患者行CTA、3D-DSA检查,全面了解动脉瘤大小、形态、朝向、瘤颈宽度,与载瘤动脉、周围分支血管的关系及与骨性结构(前床突)的关系,指导术中头位摆放,放置瘤夹角度,并结合术中电生理监测体感诱发电位(somatosensory evoked potentials,SEP)和运动诱发电位(motor-evoked potentials,MEP),经颅多普勒超声(transcranial Doppler,TCD)监测载瘤动脉及其分支血流通畅情况,吲哚菁绿(indocyanine green,ICG)血管荧光造影了解动脉瘤是否显影及血管充盈灌注情况。在完全夹闭动脉瘤颈基础上,分析术后出现动脉瘤残留及缺血性卒中发生情况。结果17例AChA动脉瘤成功精准夹闭,仅1例出现瘤颈残留情况,2例出现脑梗死。随访10~20个月,无动脉瘤再出血与复发情况。改良RANKIN量表(modified Rankin scale,mRS)评分:0分5例,1分7例,2分4例,3分1例,4分1例,无死亡病例。结论术前熟练应用CTA及3D-DSA重建技术充分了解AChA动脉瘤三维结构及具体形态,准确判断夹闭动脉瘤难易度,依据术中电生理监测、TCD及ICG血管荧光造影技术明确动脉瘤夹闭后是否存在残留、载瘤动脉通畅性或穿支动脉被夹闭情况,不断调整动脉瘤夹实现最佳夹闭效果,可减少动脉瘤瘤颈残留及缺血性脑卒中发生率。Objective To investigate the application of multiple auxiliary techniques in microsurgical clipping of anterior choroidal artery(AChA)aneurysms,aiming to improve the success rate of AChA aneurysm clipping,reduce aneurysm neck remnants,and decrease the incidence of ischemic stroke.Methods The clinical data of 18 patients with AChA aneurysms were analyzed retrospectively.Among them,14 patients presented with preoperative subarachnoid hemorrhage(SAH).All the patients underwent craniotomy and microsurgical clipping(accounting for approximately 4.4%of all aneurysms clipped surgically during the same period).Preoperatively,all the patients underwent computed tomography angiography(CTA)and three-dimensional digital subtraction angiography(3D-DSA)to comprehensively assess aneurysm size,morphology,orientation,neck width,relationships with the parent artery,surrounding branch vessels,and bony structures(anterior clinoid process),guiding intraoperative head positioning and clip placement angles.Additionally,intraoperative electrophysiological monitoring of somatosensory evoked potentials(SEP)and motor-evoked potentials(MEP),transcranial Doppler(TCD)monitoring of the patency of the parent artery and its branches,and indocyanine green(ICG)videoangiography to visualize aneurysm filling and vascular perfusion were employed.Based on complete aneurysm neck occlusion,postoperative aneurysm remnants and ischemic stroke occurrences were analyzed.Results Successful and precise clipping of AChA aneurysms was achieved in 17 cases,with only 1 case showing neck remnants and 2 cases of cerebral infarction.Follow-up ranged from 10 to 20 months,during which no rebleeding or recurrence of aneurysms occurred.Modified Rankin Scale(mRS)score was as follows:0 in 5 cases,1 in 7,2 in 4,3 and 4 in 1 case respectively,with no deaths.Conclusions Preoperative proficient use of CTA and 3D-DSA reconstruction techniques to thoroughly understand the threedimensional structure and specific morphology of AChA aneurysms enables accurate assessment of the dif

关 键 词：颅内动脉瘤 脉络膜前动脉 多辅助手段 显微外科手术 

分 类 号：R651.12[医药卫生—外科学]