Satoh Toru, Ichikawa Tomotsugu, Fujii Kentaro, Date Isao
Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, Hiroshima, Japan.
Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
J Neurosurg Case Lessons. 2024 Jul 29;8(5). doi: 10.3171/CASE24194.
Silent magnetic resonance angiography reduces metal artifacts, enabling clear visualization of the clipped neck following surgical clipping of cerebral aneurysms. This study aimed to delineate the morphology of the clipped neck complex in cerebral aneurysms using three-dimensional (3D) multifusion imaging of silent magnetic resonance angiography and fast spin echo magnetic resonance cisternography. Additionally, computational fluid dynamics analysis was utilized to evaluate the hemodynamics of the parent vessel at the clipped neck, allowing for a detailed assessment of hemodynamics at the clipped neck.
The 3D multifusion image enabled visualization of the orientation and shape of the clip within the clipped neck complex, alongside the morphology of the parent vessel. In the hemodynamic analysis of the parent vessel at the clipped neck, areas of high-intensity magnitude of wall shear stress (WSSm) variation corresponding to the clip's contour, along with significant vector of wall shear stress (WSSv) variation related to vector directionality, were visualized in 3D. The intentional residual neck, coated with muscle grafts, was depicted as an area with low WSSm variation values and high WSSv variation values.
Three-dimensional multifusion imaging, along with computational fluid dynamics analysis of the parent vessels, facilitated both the morphological and hemodynamic visualization and assessment of the clipped neck complex following neck clipping surgery for cerebral aneurysms. https://thejns.org/doi/10.3171/CASE24194.
静音磁共振血管造影可减少金属伪影，能清晰显示脑动脉瘤手术夹闭后夹闭的颈部情况。本研究旨在利用静音磁共振血管造影的三维（3D）多融合成像和快速自旋回波磁共振脑池造影来描绘脑动脉瘤夹闭颈部复合体的形态。此外，利用计算流体动力学分析来评估夹闭颈部母血管的血流动力学，从而对夹闭颈部的血流动力学进行详细评估。
3D多融合图像能够显示夹闭颈部复合体内夹子的方向和形状，以及母血管的形态。在夹闭颈部母血管的血流动力学分析中，在3D中可以看到与夹子轮廓相对应的高壁面切应力幅值（WSSm）变化区域，以及与矢量方向性相关的显著壁面切应力矢量（WSSv）变化。涂有肌肉移植物的有意残留颈部被描绘为WSSm变化值低且WSSv变化值高的区域。
三维多融合成像以及母血管的计算流体动力学分析，有助于对脑动脉瘤颈部夹闭手术后夹闭颈部复合体进行形态学和血流动力学的可视化及评估。https://thejns.org/doi/10.3171/CASE24194。
