Nagasawa S, Ohta T, Tsuda E
Department of Neurosurgery, Osaka Medical College, Takatsuki City, Takatsuki, Japan.
Surg Neurol. 1998 Jul;50(1):62-4. doi: 10.1016/s0090-3019(97)00027-x.
To evaluate the usefulness of magnetic resonance (MR) angiographic source images for determining the feasibility of M1 segment control via the distal approach in pterional craniotomy for middle cerebral artery (MCA) aneurysms.
MR angiographic source and conventional angiographic source images were obtained in 40 patients with MCA aneurysms. Each aneurysm was treated surgically using a pterional craniotomy. We initially approached the aneurysm distally. When this was judged inappropriate, the approach was altered to proximally. We compared the topography based on these angiograms to that confirmed during surgery.
MR angiographic source images visualized the aneurysm, the M1 and M2 segments of the MCA, the insula, and the frontal and temporal opercula in all 40 patients. In 22 (55%) of them, the distal portion of the M1 segment was recognized from the posterolateral perspective between the aneurysmal neck and the insular surface. These aneurysms were successfully clipped via the distal approach after definite proximal control of the MCA was obtained.
It was concluded that MR angiographic source images have a distinguishing feature in defining cerebral tissue-vascular relationships and that they are useful in the surgical planning for MCA aneurysms.
评估磁共振（MR）血管造影源图像在确定经翼点入路手术治疗大脑中动脉（MCA）动脉瘤时通过远端入路控制M1段的可行性方面的作用。
对40例MCA动脉瘤患者获取MR血管造影源图像和传统血管造影源图像。每例动脉瘤均采用翼点入路进行手术治疗。我们最初采用远端入路处理动脉瘤。若判断该入路不合适，则改为近端入路。我们将基于这些血管造影的解剖结构与手术中确认的情况进行比较。
MR血管造影源图像在所有40例患者中均显示了动脉瘤、MCA的M1和M2段、岛叶以及额颞叶脑盖。其中22例（55%）患者，从动脉瘤颈与岛叶表面之间的后外侧视角可识别出M1段的远端部分。在对MCA进行确切的近端控制后，这些动脉瘤通过远端入路成功夹闭。
得出结论，MR血管造影源图像在定义脑组织与血管关系方面具有显著特征，并且在MCA动脉瘤的手术规划中有用。
