摘要目的 应用多排螺旋CT血管成像(MSCTA)分析脑膜瘤与邻近脑内大动脉间的关系,探讨其在术前肿瘤切除计划制定中的应用价值.方法 回顾性纳入2004年1月至2016年1月在中南大学湘雅医学院附属海口医院神经外科行手术治疗的32例脑膜瘤患者,术前均行MSCTA检查,观察瘤体与邻近脑内大动脉(直径≤3 cm)间的关系,按照血管被肿瘤推移、包裹及侵袭的程度分为Ⅰ～Ⅳ4型,并据此制定肿瘤切除计划.结果 32例患者中,MSCTA检查脑膜瘤与邻近大动脉关系的分型中,Ⅰ型3例(9.4％),Ⅱ型10例(31.3％),Ⅲ型9例(28.1％),Ⅳ型10例(31.3％),其中Ⅳa型3例,Ⅳb型5例,Ⅳc型2例.MSCTA三维分型与术中所见符合率为96.9％(31/32).术前依据分型制定的瘤体切除方案,术中证实合理.术后Simpson Ⅰ级切除10例(31.3％),Ⅱ级切除5例(15.6％),Ⅳ级切除17例(51.1％).术后6个月内无脑内大动脉损伤相关并发症.结论 MSCTA可准确评估脑膜瘤与邻近脑内大动脉间的关系,有助于肿瘤切除术中正确处理与肿瘤邻近的脑内大动脉.

abstractsObjective To evaluate the relationship between meningiomas and adjacent large cerebral arteries by multi-slice spiral CT angiography (MSCTA) and its clinical significance in preoperative planning of tumor resection.Methods A retrospective analysis was conducted on 32 patients with meningiomas who were admitted to the Affiliated Haikou Hospital,Xiangya School of Medicine,Central South University and nnderwent surgical operations from January 2004 to January 2016.MSCTA was conducted for all patients to evaluate the relationship between the tumors and adjacent (≤ 3 cm) cerebral large arteries.The relationship was categorized into 4 types according to the degree of compression,embedding or erosion,based on which the operational plan for tumor resection was made.Results All 32 patients included 3 (9.4％) cases in type Ⅰ,l0 (31.3％) in type Ⅱ,9 (28.1％) in type Ⅲ andl0 (31.3％) in type Ⅳ (3 in type Ⅳa,5 in type Ⅳb,and 2 in type Ⅳc).The coincidence rate of MSCTA classification with intraoperative findings was 96.9％ (31/32).The tumor resection plan preoperatively made according to the classification was proved to be reasonable during surgery.The Simpson grade Ⅰ resection was performed in 10 (31.3％) cases,Simpson Ⅱ resection in 5 (15.6％) cases,and Simpson Ⅳ resection in 17 (51.1％) cases.The follow-up 6 months post operation did not report any complications related to damages of cerebral large arteries.Conclusion MSCTA could be used to accurately assess the relationship between meningiomas and adjacent large cerebral arteries and help with proper treatment of the nearby arteries during tumor resection.