关键词: 手术中血管造影, 脑血管外科, 动静脉畸形, 动脉瘤, 脑血管疾病

Abstract: Objective To evaluate the clinical value of intraoperative angiography during emergency operation for cerebrovascular diseases of the hemorrhagic type.Methods From July 2003 to February 2006,15 consecutive patients with acute hemorrhagic stroke(7 female and 8 male patients,mean age 36 years) underwent emergency operation assisted with intraoperative angiography in our institute.Of these patients,there were 10 cases of AVMs with nidus diameter from 2 cm to 7 cm,including 2 cases with of large AVMs(diameter≥6 cm);the other 5 cases were aneurysms including 1 case of giant aneurysm(diameter≥2.5 cm).The preoperative Hunt-Hess grading in these patients was grade 1 in 1,grade 2 in 2 and grade 3 in 2.After intubation was achieved and general anesthesia administrated,the patient's right femoral artery was catheterized successfully with the catheter reaching the intracranial artery,which would be involved during the surgery.After the lesion had been treated,such as AVMs being resected or the aneurysm being clipped,the intraoperative angiography was performed.Results All of these 15 patients underwent emergency operation for acute intracranial hemorrhage without preoperative angiography.Ten patients were estimated to have AVMs as assisted with intraoperative angiography,while the other 5 patients revealed aneurysms.Thirteen of 15(86.7%) patients had been treated successfully,1 patient(6.7%) with ophthalmic artery aneurysm was estimated to have residual aneurysm and being undergone clip adjustment.One patient(6.7%) had motor dominant zone residual AVMs,which was noted and resected.There was no operation mortality,no unexpected major artery occlusion.No complication attributable to angiography noted.Intraoperative angiography took 60 to 145 min with a mean time of 83 minutes.Conclusion Intraoperative angiography detects the position of unexpected residual aneurysms or AVMs nidus and occlusion of major artery,helps surgeons to modify technical faults to prevent from reoperation,and can decrease complication of cerebrovascular surgery.

Key words: intraoperative angiography, cerebrovascular surgery, AVMs, aneurysms, cerebrovascular disorders