Takeichi Y, Kojima M, Lee H, Funatsu N, Kyoushima K, Mabuchi N, Tsuda E, Nagasawa S
Department of Neurosurgery, Soseikai General Hospital, Kyoto.
No Shinkei Geka. 1997 May;25(5):411-6.
This study evaluated the usefulness of axial source images of magnetic resonance angiography (MRA) on preoperative depiction of surgical topography around posterior communicating artery aneurysms. Twenty patients with posterior communicating artery aneurysms, two ruptured and eighteen unruptured, underwent conventional angiography as well as axial source and projection images obtained by three-dimensional time-of-flight MRA techniques. By comparing the topography based on these angiograms to that confirmed during surgery, we evaluated useful information specific to the source images of MRA. Source images of MRA visualized the posterior communicating artery and the anterior choroidal artery in eighteen cases (90%) and five cases (25%), respectively. The posterior communicating artery was recognized at a higher rate by source images of MRA than by conventional angiography (65%), while the anterior choroidal artery was recognized at a lower rate than by combined angiography (75%). We realized some specific information to the source images of MRA including the topographical relations between the aneurysmal neck and the orifice of the posterior communicating artery, the relations between the aneurysmal dome and the oculomotor nerve and the aneurysmal dome buried into the temporal lobe. The information suggested a satisfactory direction of safe aneurysmal clipping so as not to occlude the posterior communicating artery. It was concluded that the source images of MRA provided additional useful information on surgical topography in 60% of the cases involving posterior communicating artery aneurysms. Although not essential in every case, the information would be beneficial in cases with the aneurysmal dome suspected to be in the temporal lobe or when the surrounding topography can not be clearly understood by angiography.
本研究评估了磁共振血管造影（MRA）的轴位源图像在术前描绘后交通动脉瘤周围手术解剖结构方面的实用性。20例后交通动脉瘤患者，其中2例破裂，18例未破裂，接受了传统血管造影以及通过三维时间飞跃MRA技术获得的轴位源图像和投影图像。通过将基于这些血管造影的解剖结构与手术中确认的解剖结构进行比较，我们评估了MRA源图像特有的有用信息。MRA源图像分别在18例（90%）和5例（25%）中显示了后交通动脉和脉络膜前动脉。MRA源图像识别后交通动脉的比例高于传统血管造影（65%），而识别脉络膜前动脉的比例低于联合血管造影（75%）。我们认识到了一些MRA源图像特有的信息，包括瘤颈与后交通动脉开口之间的解剖关系、瘤顶与动眼神经之间的关系以及埋入颞叶的瘤顶。这些信息提示了安全夹闭动脉瘤的满意方向，以免闭塞后交通动脉。得出的结论是，在60%的涉及后交通动脉瘤的病例中，MRA源图像提供了关于手术解剖结构的额外有用信息。虽然并非在每个病例中都必不可少，但在怀疑瘤顶位于颞叶或血管造影无法清晰了解周围解剖结构的病例中，这些信息将是有益的。
