CT and CTA 3D-reconstruction of keyhole operation approaches in the saddle area / 中华神经医学杂志

ABSTRACT

Objective To comprehend the anatomical image data related to the keyhole microsurgery operation approaches in patients with saddle lesions.Methods Fifteen healthy volunteers and 10 patients with intracranial aneurysm were selected in the experiment and 16-slice spiral CT, CT angiography (CTA) and 3D-reconstruction were performed on them. The anatomitical distance and angle were measured through the ways from supraorbital keyhole approach, frontolateral keyhole approach, pterional keyhole approach, and subtemporal keyhole approach to the anterior/posterior clinoid process, the anterior communicating artery and the bifurcation of internal carotid. Results Of the distances between keyhole centre and anterior/posterior clinoid process, the shortest one was the way from subtemporal keyhole approach (4.98±0.54 em; 5.35±0.65 cm) and the longest one was the way from supraorbital keyhole approach (6.44±0.36 cm; 37.68±1.06 cm). Of the angles between the skull sagittal plane and the operation plane from keyhole centre to anterior/posterior clinoid process, the way from subtemporal keyhole approach was better than the way from frontolateral keyhole approach. Of the angles between skull transverse plane and the operation plane from keyhole centre to anterior/posterior clinoid process, that of subtemporal keyhole approach was better than pterional keyhole approach. Distances between keyhole centre and bifurcation of intemal carotid ordered as follows: the way from frontolateral keyhole approach, that from supraorbital keyhole approach, that from subtemporal keyhole approach and that from pterional keyhole approach. Of the angles between cranial sagittal plane and the operation plane from keyhole centre to the anterior communicating artery or the bifurcation of ipsilateral internal carotid,the way of frontolateral keyhole approach was better than that of supraorbital keyhole approach.Conclusion CT and CTA 3D-reconstruction, by demonstrating the distances and angles of each approach,play a significant role in choosing the right keyhole operation approach in different saddle lesions.