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Neurological Surgery No Shinkei Geka Volume 29, Issue 12 （December 2001）

Neurological Surgery 脳神経外科 29巻12号（2001年12月発行）

Japanese English

研究

3D-CTAによる頭蓋内静脈の評価—脳動脈瘤手術の観点から Evaluation of Venous System with 3D-CTA : From the Viewpoint of Treatment to Cerebral Aneurysm 遠藤孝裕 ¹ , 鈴木泰篤 ¹ , 池田尚人 ² , 神保洋之 ² , 池田幸穂 ² , 松本清 ² Takahiro ENDO ¹ , Yasuhiro SUZUKI ¹ , Hisato IKEDA ² , Hiroyuki JINBO ² , Yoshiho IKEDA ² , Kiyoshi MATSUMOTO ² ¹セコメディック病院脳神経外科 ²昭和大学医学部脳神経外科 ¹Department of Neurosurgery, SECOMEDIC Hospital ²Department of Neurosurgery, Showa University School of Medicine キーワード： pterional approach , superficial middle cerebral vein , sylvian vein , basal vein , three-dimensional CT angiography（3D-CTA） Keyword: pterional approach , superficial middle cerebral vein , sylvian vein , basal vein , three-dimensional CT angiography（3D-CTA） pp.1167-1174

発行日 2001年12月10日 Published Date 2001/12/10

DOI https://doi.org/10.11477/mf.1436902136

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Abstract 文献概要
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I．はじめに

　近年，脳動脈瘤の治療にあたり，脳血管造影を行わなくとも，three-dimensional CT angiogra-phy（3D-CTA）からの情報のみで手術が可能であるとの報告が多い^{3,11,21,29）}．しかし，これらの報告では脳血管造影と比較して脳動脈瘤と親血管の描出能の優秀さのみを強調した内容に終始しているように思われる．一方，術後合併症においてはpterional approachを例として取り上げても静脈系の関与が重要な要因となっている^{2,7,16,20,27）}．このようなことから，脳血管造影を行わないことで静脈系の情報が確認されないまま手術に臨んでしまうことが危惧される．3D-CTAから得られる静脈系の情報が術前検索に利用できるかは重要な問題と思われる．今回われわれは，内頸動脈周囲に介在する静脈系について3D-CTAを用い，その描出能を検討した．

Background and Purpose: Recently, many reports have suggested that cerebral aneurysms can be treated under diagnoses based only on the information obtained from three-dimensional CT angiography (3D-CTA). However, these reports have mainly emphasized the excellence of the stereoscopic images of aneurysms and the relationships with the arteries, and almost never discuss the venous information. The present study used 3D-CTA images to evaluate potential problems in the venous system which may affect the pterional approach.

Patients and Technique: This study included 500 sides of 250 patients who underwent screening for cere-brovascular diseases by 3D-CTA. The voxel-transmission method was used for 3D reconstruction. 3D-CTA images in axial stereoscopic views were mainly evaluated, with views in other directions.

Results: The variations of the superficial middle cerebral vein draining the sphenoparietal sinus and caver-nous sinus were related to the operative view to assess the potential for venous damage. Potential locations of venous damage to the basal vein include the veins of the first segment draining from the frontal base, the direct communication of the basal vein with the sphenoparietal sinus or cavernous sinus, and the veins of the first segment which independently form the uncal vein draining the sphenoparietal sinus or caver-nous sinus.

Concluston: 3D-CTA demonstrates the venous system and the spatial relationships with other structures clearly. Such information will help neurosurgeons to construct a better and safer microdissection plan, which will preserve the venous system and help prevent postoperative neurological deficits.