Okazaki Toshiyuki, Irie Shinsuke, Inagaki Toru, Saito Osamu, Yamashina Motoshige, Hayase Hitoshi, Nakagawa Hiroshi, Nagahiro Shinji, Saito Koji
Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro, Japan; Department of Neurosurgery, Tokushima University, Tokushima, Japan.
Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro, Japan.
World Neurosurg. 2018 Apr;112:e113-e118. doi: 10.1016/j.wneu.2017.12.152. Epub 2018 Jan 31.
Superficial temporal artery (STA)-to-middle cerebral artery (MCA) bypass is an established surgical technique for achieving revascularization. It is important to select the proper recipient artery of the MCA. Three-dimensional computed tomographic angiography (3D-CTA) and conventional angiography are useful in the selection process but need contrast agents. The authors have designed a coloring MRA technique that needs no agents to visualize the recipient artery. Retrospective evaluation of the efficacy and limitation for selection of the recipient artery and decision of the place and size of the craniotomy were carried out.
The authors performed the coloring MRA before operation since January 2013. Ninety-two patients underwent STA-MCA bypass for atherosclerotic stenosis or occlusion of internal carotid artery (ICA), MCA with reference to the coloring MRA. To evaluate the efficacy of coloring MRA, the control group consisted of 75 patients who underwent STA-MCA bypass between January 2012 to November 2013 with reference to 3D-CTA. The size of craniotomy was retrospectively calculated and compared.
Neither additional craniotomy nor wrong selection of the recipient artery was done in either group. There was no significant difference in size between the 2 groups in both single and double bypass.
The coloring MRA technique was not inferior to 3D-CTA with respect to the size of craniotomy. This novel technique was found to be very helpful not only for the virtual identification of the proper recipient artery but also for preoperative simulation such as decisions about length of donor artery, location, and size of craniotomy.
颞浅动脉（STA）-大脑中动脉（MCA）搭桥术是一种成熟的实现血管重建的外科技术。选择合适的MCA受区动脉很重要。三维计算机断层血管造影（3D-CTA）和传统血管造影在选择过程中很有用，但需要使用造影剂。作者设计了一种无需造影剂即可可视化受区动脉的彩色MRA技术。对受区动脉选择、开颅位置和大小决策的有效性及局限性进行了回顾性评估。
作者自2013年1月起在术前进行彩色MRA检查。92例患者因颈内动脉（ICA）、MCA的动脉粥样硬化性狭窄或闭塞，参照彩色MRA行STA-MCA搭桥术。为评估彩色MRA的有效性，对照组由75例在2012年1月至2013年11月间参照3D-CTA行STA-MCA搭桥术的患者组成。对开颅大小进行回顾性计算并比较。
两组均未出现额外开颅或受区动脉选择错误的情况。单旁路和双旁路时两组在大小上均无显著差异。
在开颅大小方面，彩色MRA技术不逊色于3D-CTA。发现这种新技术不仅对虚拟识别合适的受区动脉非常有帮助，而且对术前模拟，如供体动脉长度、开颅位置和大小的决策也很有帮助。
