Application of pterional approach head positional three-dimensional digital subtraction angiography in intracranial aneurysm surgery / 中国脑血管病杂志

ABSTRACT

Objective: To investigate the guiding significance of pterional approach head positional three-dimensional digital subtraction angiography (3D-DSA) in intracranial aneurysm clipping. Methods: One hundred fifty patients with aneurysmal subarachnoid hemorrhage were enrolled in the study. Three-dimenlional angiography was performed after detecting the aneurysms with conventional angiography, and then, the images of 3D-DSA were rotated to the head position for the pterional approach. The size of aneurysm, spatial location, aneurysm neck, and the relationship between aneurysm and patent artery revealed by the images were compared to the conditions at surgical exposure through pterional approach. Results: Of the 150 patients, the diameter of aneurysm revealed by 3D-DSA in 140 patients were in accordance with the intraoperative measurements, the coincidence rate was 93.3%; the coincidence rate of the spatial location between the aneurysms and its parent arteries was 100%. A total of 149 aneurysm clips were selected before the surgery according to 3D-DSA. Six clips were replaced during the operation because it was inconsistence with the prediction before the surgery, and the accurate rate was 96.0% (143/149). The related perforating arteries or adjacent vascular branches of aneurysms in 49 patients were identified before the surgery according to 3D-DSA. The major adjacent blood vessels missed by 3D-DSA in 11 patients were detected during the surgery, and the coincidence rate reached 81.7%. These vessels were all completely preserved during intraoperative anatomical separation under the direct vision. Conclusion: Head positional 3-D DSA for simulate pterional approach may accurately provide information of local blood vessels of aneurysm before surgery, and it plays a good guiding role for surgical clipping of aneurysms.