CT三维血管成像技术在颅底脑膜瘤术前评估的应用价值
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摘要
目的探讨头部CT三维血管成像检查对颅底脑膜瘤术前评估的应用价值。方法回顾性分析玉林市第一人民医院神经外科手术治疗的28例颅底脑膜瘤患者的资料。患者术前均进行头部CT三维血管成像检查,了解肿瘤与血管的关系;术中采取适当的手术策略切除肿瘤,同时保护血管。结果术前头部CT三维血管成像检查能显示肿瘤的大小、基底、供血来源,以及颅内动脉3级结构;并能清楚地显示肿瘤、血管、颅骨的三维影像关系,能分辨肿瘤与附近血管的直接关系。手术结果:SimponⅡ级切除者8例,Ⅲ级切除者16例,Ⅳ级切除者4例;术后无发生脑梗死和血管损伤的患者。术后,Karnofsky评分较术前平均提高17. 5分;随访6～36个月,25例患者无复发,3例患者残留肿瘤复发,再次手术。结论术前CT三维血管成像能分辨颅底肿瘤与附近血管的关系,利于血管保护;为颅底脑膜瘤手术提供直观的信息。
Objective To evaluate the application value of head CT angiography for preoperative evaluation of patients with skull base meningioma. Methods The clinical data of 28 patients with skull base meningioma were analyzed retrospectively. To learn the relationship between tumor and blood vessels,preoperative head CTA examination was taken. The appropriate surgical resection was taken to protect the blood vessels. Results Preoperative head CTA showed the size of the tumor,the base,and the source of blood supply. It showed the third-level structure of the intracranial artery. It clearly showed the three-dimensional image relationship of tumors,blood vessels,and skulls,and can distinguish between tumors and nearby blood vessels. The results of the operation showed that 8 cases of Simon Ⅱ stage resection,16 of Ⅲ stage resection,and 4 of Ⅳstage resection. No cerebral infarction,no vascular damage after operation. Karnofsky scored 17. 5 points higher than the preoperative average,followed up 6 to 36 months. 25 patients had no recurrence,and 3 had residual tumor growth recurrence. Conclusion The preoperative CTA can distinguish the relationship between the skull base tumor and the adjacent blood vessel,which is beneficial to the protection of blood vessels,and provides intuitive information for the operation of skull base meningioma.
Objective To evaluate the application value of head CT angiography for preoperative evaluation of patients with skull base meningioma. Methods The clinical data of 28 patients with skull base meningioma were analyzed retrospectively. To learn the relationship between tumor and blood vessels,preoperative head CTA examination was taken. The appropriate surgical resection was taken to protect the blood vessels. Results Preoperative head CTA showed the size of the tumor,the base,and the source of blood supply. It showed the third-level structure of the intracranial artery. It clearly showed the three-dimensional image relationship of tumors,blood vessels,and skulls,and can distinguish between tumors and nearby blood vessels. The results of the operation showed that 8 cases of Simon Ⅱ stage resection,16 of Ⅲ stage resection,and 4 of Ⅳstage resection. No cerebral infarction,no vascular damage after operation. Karnofsky scored 17. 5 points higher than the preoperative average,followed up 6 to 36 months. 25 patients had no recurrence,and 3 had residual tumor growth recurrence. Conclusion The preoperative CTA can distinguish the relationship between the skull base tumor and the adjacent blood vessel,which is beneficial to the protection of blood vessels,and provides intuitive information for the operation of skull base meningioma.
引文
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[3]杨震,胡焱,徐东为,等.脑血管造影及供血动脉栓塞在富血供脑膜瘤手术中的应用效果[J].临床医学研究与实践,2017,2:52.
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[10]魏栋,胡卫星,顾培元,等.螺旋CT血管造影及三维重建技术辅助脑深部肿瘤显微手术的应用研究[J].临床神经外科杂志,2013,10:166.
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[12]Oishi M,Fukuda M,Ishida G,et al. Prediction of the microsurgical window for skull-base tumors by advanced three-dimensional multifusion volumetric imaging[J]. Neurol Med Chir(Tokyo),2011,51:201.
[13]陈永汉,李国京,樊爱华,等. 64排螺旋CT在颅底肿瘤手术前的应用[J].中国医师进修杂志,2008,31:48.
[14]赵亚伟,纪盛章. CT三维重建技术在神经外科手术计划中的应用[J].中华神经外科杂志,1996,12:116.
[15]Suzuki K,Nagaishi M,Matsumoto Y,et al. Preoperative embolization for skull base meningiomas[J]. J Neurol Surg B Skull Base,2017,78:308.
[16]Waldron JS,Sughrue ME,Hetts SW,et al. Embolization of skull base meningiomas and feeding vessels arising from the internal carotid circulation[J]. Neurosurgery, 2011, 68:162;discussion 169.
[17]谭源福,肖绍文,张超元,等.显微切除天幕脑膜瘤69例临床分析[J].中华显微外科杂志,2016,39:63.
[18]黄文跃,高金华.显微手术治疗前颅底脑膜瘤(附25例报告)[J].东南大学学报:医学版,2015,34:557.
[19]刘浏,潘轲.螺旋CT三维血管成像技术术前评估颅底脑膜瘤的价值[J].中国实用神经疾病杂志,2016,19:3.
[20]张俊廷,李达,郝淑煜,等.岩斜区脑膜瘤手术治疗及预后分析[J].中华神经外科杂志,2012,28:327.
[21]陈琪,李国强,李惊涛,等.鞍区脑膜瘤患者的临床特征及预后影响因素分析[J].西部医学,2017,29:799.
[2]王斐斐,程敬亮,王琳琳,等.脑膜瘤肿瘤血管的磁敏感加权成像表现[J].肿瘤基础与临床,2017,30:255.
[3]杨震,胡焱,徐东为,等.脑血管造影及供血动脉栓塞在富血供脑膜瘤手术中的应用效果[J].临床医学研究与实践,2017,2:52.
[4]陈建强,韩向君,战跃福,等.脑膜瘤35例血供分析[J].介入放射学杂志,2011,20:53.
[5]王晓军,张鑫,卞杰勇,等. CTA在破裂动脉瘤诊治中的应用价值[J].临床神经外科杂志,2012,9:74.
[6]宋明,王田力,李坚,等. CTA在神经外科的应用[J].中华神经外科杂志,2000,16:33.
[7]Toh CH,Wei KC,Chang CN,et al. Assessment of angiographic vascularity of meningiomas with dynamic susceptibility contrastenhanced perfusion-weighted imaging and diffusion tensor imaging[J]. Am J Neuroradiol,2014,35:263.
[8]Bash S,Villablanca JP,Jahan R,et al. Intracranial vascular stenosis and occlusive disease:evaluation with CT angiography,Mr angiography,and digital subtraction angiography[J]. Am J Neuroradiol,2005,26:1012.
[9]杨俊,吴雪松,莫鸿忠,等.双源CT三维血管成像技术在脑膜瘤术前评估中的应用[J].中国临床神经外科杂志,2015,20:347.
[10]魏栋,胡卫星,顾培元,等.螺旋CT血管造影及三维重建技术辅助脑深部肿瘤显微手术的应用研究[J].临床神经外科杂志,2013,10:166.
[11]陈锐.显微手术治疗32例颅底脑膜瘤的临床分析[J].医学信息,2014,27:451.
[12]Oishi M,Fukuda M,Ishida G,et al. Prediction of the microsurgical window for skull-base tumors by advanced three-dimensional multifusion volumetric imaging[J]. Neurol Med Chir(Tokyo),2011,51:201.
[13]陈永汉,李国京,樊爱华,等. 64排螺旋CT在颅底肿瘤手术前的应用[J].中国医师进修杂志,2008,31:48.
[14]赵亚伟,纪盛章. CT三维重建技术在神经外科手术计划中的应用[J].中华神经外科杂志,1996,12:116.
[15]Suzuki K,Nagaishi M,Matsumoto Y,et al. Preoperative embolization for skull base meningiomas[J]. J Neurol Surg B Skull Base,2017,78:308.
[16]Waldron JS,Sughrue ME,Hetts SW,et al. Embolization of skull base meningiomas and feeding vessels arising from the internal carotid circulation[J]. Neurosurgery, 2011, 68:162;discussion 169.
[17]谭源福,肖绍文,张超元,等.显微切除天幕脑膜瘤69例临床分析[J].中华显微外科杂志,2016,39:63.
[18]黄文跃,高金华.显微手术治疗前颅底脑膜瘤(附25例报告)[J].东南大学学报:医学版,2015,34:557.
[19]刘浏,潘轲.螺旋CT三维血管成像技术术前评估颅底脑膜瘤的价值[J].中国实用神经疾病杂志,2016,19:3.
[20]张俊廷,李达,郝淑煜,等.岩斜区脑膜瘤手术治疗及预后分析[J].中华神经外科杂志,2012,28:327.
[21]陈琪,李国强,李惊涛,等.鞍区脑膜瘤患者的临床特征及预后影响因素分析[J].西部医学,2017,29:799.