Suzuki Yasuhiro, Nakajima Masateru, Ikeda Hisato, Ikeda Yukio, Abe Takumi
Department of Neurosurgery, SECOMEDIC Hospital, Funabashi, Chiba, Japan.
Surg Neurol. 2004 Apr;61(4):357-64; discussion 364. doi: 10.1016/j.surneu.2003.06.002.
Variations of the venous system affecting the surgical treatment of cerebral aneurysm were evaluated using three-dimensional computed tomography angiography (3D-CTA) to evaluate the essential aspects of preoperative diagnosis.
This study included 50 patients who underwent clipping of cerebral aneurysm through the pterional and trans-sylvan approaches. The 3D-CTA and operative findings were compared to assess the characteristics of cases in which the veins restrict brain retraction, hinder operative manipulations or require sacrifice because of the position in the operative field.
Superficial sylvian veins that restricted brain retraction were identified in 8 cases. The veins entered the cavernous sinus in a relatively high position just below either the sphenoid ridge (superior lateral type) or the anterior clinoid process (superior medial type), and the veins entering at a more medial position were closer to the spatula and tended to be compressed or directly excluded (superior medial type). The inferior medial type did not tend to become tense and so did not restrict brain retraction. The inferior lateral type hardly affected the operative manipulation. The first segment of the basal vein of Rosenthal, the uncal vein entering the cavernous sinus, or the sphenoparietal sinus were located in the operative field in six cases, and affected the manipulation of dissecting arteries, and exposure and clipping of the aneurysm.
3D-CTA provides essential information for operative planning to protect the venous system during the pterional and trans-sylvian approaches.
利用三维计算机断层扫描血管造影术（3D-CTA）评估影响脑动脉瘤手术治疗的静脉系统变异，以评估术前诊断的关键方面。
本研究纳入50例经翼点入路和经外侧裂入路夹闭脑动脉瘤的患者。比较3D-CTA和手术结果，以评估静脉因在手术视野中的位置而限制脑牵拉、妨碍手术操作或需要牺牲的病例特征。
8例患者发现限制脑牵拉的外侧裂浅静脉。这些静脉在蝶骨嵴下方（上外侧型）或前床突下方（上内侧型）相对较高的位置进入海绵窦，进入位置更内侧的静脉更靠近脑压板，且易于受压或直接被排除（上内侧型）。下内侧型不易紧张，因此不限制脑牵拉。下外侧型几乎不影响手术操作。6例患者中，大脑基底静脉第一段、进入海绵窦的钩静脉或蝶顶窦位于手术视野内，影响动脉解剖、动脉瘤暴露及夹闭操作。
3D-CTA为翼点入路和经外侧裂入路手术规划提供关键信息，以保护静脉系统。
