Villavicencio A T, Gray L, Leveque J C, Fukushima T, Kureshi S, Friedman A H
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Neurosurgery. 2001 Feb;48(2):318-26; discussion 326-7. doi: 10.1097/00006123-200102000-00014.
The optimal surgical exposure for basilar tip aneurysms is dictated by the relationship of the basilar bifurcation to the cranial base. This study was designed to evaluate three-dimensional computed tomographic angiography as a means of obtaining detailed anatomic information on the basilar artery and the surrounding cranial base in individual patients before surgery.
We studied 30 patients using three-dimensional computed tomographic angiographic reconstructions from 1-mm computed tomographic slices. Detailed anatomic measurements were performed to define the relationship between the basilar artery and the cranial base. Particular attention was paid to the height of the dorsum sellae and its relationship to the basilar bifurcation.
The heights of the basilar apex and the vertebrobasilar junction, relative to the cranial base, were extremely variable. Considerable asymmetries in the heights of the left and right posterior clinoid processes were identified; in one case, this difference was more than 1 cm (mean difference in height, 0.9 mm; range, 0-10.3 mm). The heights of the posterior clinoid processes above the sellar floor ranged from 5.8 to 14.1 mm (mean height, 9.5 mm). We were able to determine the feasibility of the pterional/orbitozygomatic, middle fossa/ anterior petrosal, and presigmoid retrolabyrinthine approaches to an individual basilar bifurcation. We also estimated the amount of bone removal required and determined the operative distances via those approaches.
Three-dimensional computed tomographic angiography is a useful tool for assessing critical anatomic relationships and represents an adjunct to conventional angiography in the planning of individualized, precisely tailored, cranial base approaches to the vertebrobasilar system.
基底动脉尖部动脉瘤的最佳手术显露方式取决于基底动脉分叉与颅底的关系。本研究旨在评估三维计算机断层血管造影术，作为术前获取个体患者基底动脉及周围颅底详细解剖信息的一种方法。
我们对30例患者进行了研究，使用1毫米计算机断层扫描切片的三维计算机断层血管造影重建。进行详细的解剖测量以确定基底动脉与颅底之间的关系。特别关注鞍背的高度及其与基底动脉分叉的关系。
相对于颅底，基底动脉尖部和椎基底动脉交界处的高度变化极大。发现左右后床突高度存在明显不对称；在1例患者中，这种差异超过1厘米（高度平均差异为0.9毫米；范围为0 - 10.3毫米）。鞍底上方后床突的高度范围为5.8至14.1毫米（平均高度为9.5毫米）。我们能够确定针对个体基底动脉分叉采用翼点/眶颧、中颅窝/岩骨前部和乙状窦前迷路后入路的可行性。我们还估计了所需的骨切除量，并确定了通过这些入路的手术距离。
三维计算机断层血管造影术是评估关键解剖关系的有用工具，在规划针对椎基底系统的个体化、精确定制的颅底入路时，是传统血管造影的辅助手段。
