本文選題：顱內(nèi)動脈瘤　切入點：蛛網(wǎng)膜下腔出血　出處：《中國腦血管病雜志》2017年10期 　論文類型：期刊論文

【摘要】：目的探討顱內(nèi)動脈瘤夾閉術中DSA結合容積再現(xiàn)技術(VRT)的應用價值。方法回顧性連續(xù)納入2016年1月至7月入住江蘇省蘇北人民醫(yī)院神經(jīng)外科的顱內(nèi)動脈瘤患者19例,均行開顱夾閉術。夾閉后即刻行DSA并利用VRT處理相關圖像,對夾閉效果欠佳者調(diào)整動脈瘤夾后,直至造影證實夾閉滿意。將動脈瘤無復發(fā)且格拉斯哥預后評分為4~5分評價為治療效果良好。結果 19例患者共計26個動脈瘤,顯微鏡下觀察均完全夾閉。經(jīng)造影證實,18個動脈瘤首次完全夾閉,1個基底動脈頂端動脈瘤其對側大腦后動脈夾閉并伴有瘤頸殘留,1個前交通動脈動脈瘤將對側A2夾閉,1個后交通動脈動脈瘤將脈絡膜前動脈完全夾閉,3個瘤頸部殘留,1個大腦中動脈分叉處動脈瘤夾閉后上干血管狹窄,1個前交通動脈動脈瘤夾閉后前交通動脈及對側A2起始處狹窄。2個因術中動脈瘤破裂出血未能調(diào)整外,其余經(jīng)調(diào)整后夾閉理想。2例嚴重腦血管痙攣中,1例經(jīng)導管緩慢注射罌粟堿后好轉(zhuǎn),1例應用罌粟堿腦棉片局部濕敷后好轉(zhuǎn)。術中DSA及VRT圖像處理時間30~100 min,未發(fā)生造影相關并發(fā)癥。術后隨訪3~16個月,CT血管成像示均無動脈瘤再生長及狹窄血管閉塞,1例偏癱,18例恢復良好。結論術中DSA結合VRT有助于術中實時觀察夾閉效果、調(diào)整動脈瘤夾,可減少瘤頸殘留、載瘤動脈和瘤周血管閉塞,從而改善手術效果。
[Abstract]:Objective to evaluate the value of DSA combined with volume rendering technique in intracranial aneurysm clipping. Methods 19 patients with intracranial aneurysms admitted to the neurosurgery department of Subei people's Hospital of Jiangsu Province from January 2016 to July were included retrospectively. All patients underwent craniotomy and clipping. DSA was performed immediately after clipping and related images were processed by VRT. No recurrence of aneurysms and Glasgow prognostic score of 4 ~ 5 were evaluated as good results. Results there were 26 aneurysms in 19 patients. Under microscope, 18 aneurysms were completely clipped for the first time, 1 aneurysm at the top of the basilar artery was clipped by the contralateral posterior cerebral artery with residual aneurysm neck, and 1 aneurysm of the anterior communicating artery was found to have a contralateral A2. Clipping: 1 posterior communicating artery aneurysm completely clipped anterior choroidal artery, 3 aneurysms remained in neck, 1 aneurysm of middle cerebral artery was clipped with superior trunk stenosis, 1 aneurysm of anterior communicating artery was clipped by aneurysm of anterior communicating artery, and then anterior communicating artery was clipped. And stenosis at the beginning of contralateral A2. 2 of them failed to adjust due to ruptured aneurysm bleeding during operation. Of the remaining 2 cases of severe cerebral vasospasm, 1 case was improved after slow injection of papaverine through catheter and 1 case was improved after local wet compress with papaverine Naomian tablet. The processing time of DSA and VRT images during operation was 30 minutes and 100 minutes. After 3 ~ 16 months follow-up, CT angiography showed that no aneurysm regrowth and 1 case of hemiplegia recovered well. Conclusion Intraoperative DSA combined with VRT is helpful to observe the clamping effect in real time. Adjusting the aneurysm clip can reduce the residual of the aneurysm neck, the aneurysm carrier artery and the peri-aneurysm vessel occlusion, thus improving the surgical effect.
【作者單位】： 江蘇省蘇北人民醫(yī)院神經(jīng)外科;
【分類號】：R651.1

【相似文獻】

相關期刊論文 前1條

1 鄭冬;劉文鵬;張朝利;陳寧;趙亮;劉軍華;費軍;閆如意;;螺旋CT容積再現(xiàn)技術在椎管內(nèi)骨嵴形態(tài)學研究中的應用[J];醫(yī)學影像學雜志;2011年05期

，

本文編號：1569490