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目的:探讨椎动脉CT血管造影(CTA)在颈椎肿瘤患者中的应用及临床意义。方法:自2007年1月至2009年4月,对肿瘤累及一侧或双侧横突、椎间孔,与椎动脉关系密切的27例患者实施椎动脉CTA,男12例,女15例。年龄7～69岁,平均39.3岁。累及C1或C2者12例,累及下颈椎者15例。结果:1例多骨型纤维异常增殖症患者右侧椎动脉第二段自右侧C5横突孔进入。肿瘤累及右侧椎动脉者10例,累及左侧椎动脉者11例,累及双侧椎动脉者6例。未受累椎动脉通畅。14例患者的肿瘤包绕17支椎动脉,其中11例的14支受累椎动脉直径变细;8例患者肿瘤推挤10支椎动脉,其中6例8支受累椎动脉直径变细;5例肿瘤仅邻近椎动脉,未对椎动脉产生影响。椎动脉第一段受累者4例,第二段受累者10例,第三段受累者9例,同时累及第二和第三段者4例。根据肿瘤的性质实施姑息性切除、经瘤刮除或边缘切除,术中2例累及椎动脉第二、三段的脊索瘤患者一侧椎动脉破裂,行椎动脉结扎,术后无神经功能损害。结论:颈椎肿瘤常累及椎动脉,术前椎动脉CTA能够了解椎动脉与肿瘤和相邻骨结构的关系,评估受累椎动脉及对侧椎动脉通畅情况,指导术中暴露和处理受累椎动脉,避免术前椎动脉栓塞和术中预防性椎动脉结扎带来的潜在风险。
Objective: To investigate the application and clinical significance of vertebral artery CT angiography (CTA) in patients with cervical cancer. METHODS: From January 2007 to April 2009, vertebral arterial CTA was performed in 27 patients with tumors involving one or both transverse processes and intervertebral foramina. The vertebral artery was closely related to the vertebral artery. There were 12 males and 15 females. Age 7 to 69 years old, average 39.3 years old. Twelve patients with C1 or C2 involvement and 15 patients with lower cervical involvement. RESULTS: The second segment of the right vertebral artery in one patient with multiple bony fibril dysplasia entered from the right C5 transverse hole. There were 10 cases of tumor involving the right vertebral artery, 11 cases of left vertebral artery involvement, and 6 cases of bilateral vertebral artery involvement. Unaffected vertebral artery patency. Tumors of 14 patients surrounded 17 vertebral arteries, of which 11 were involved in the reduction of diameter of 14 vertebral arteries; 8 tumors pushed 10 vertebral arteries, 8 of them involved 8 vertebral artery diameters were thinning; 5 patients The tumor was only adjacent to the vertebral artery and did not affect the vertebral artery. The first segment of vertebral artery involvement was in 4 cases, the second segment was in 10 cases, the third segment was in 9 cases, and the second and third segments were affected in 4 cases. According to the nature of the tumor, palliative resection, resection of the tumor, or marginal resection was performed. Two patients with chordomas involving the second and third segments of the vertebral artery suffered unilateral vertebral artery rupture and vertebral artery ligation. There was no neurological impairment after operation. . Conclusion: Cervical vertebrae often involve vertebral arteries. Preoperative vertebral arterial CTA can understand the relationship between the vertebral artery and the tumor and the adjacent bone structure, assess the patency of the affected vertebral artery and contralateral vertebral artery, and guide the exposure and treatment of the affected vertebral artery. Avoid potential risks associated with preoperative vertebral artery embolization and intraoperative prophylactic vertebral artery ligation.