眼动脉段动脉瘤的手术治疗(附40例报告)

摘要

目的 探讨颈内动脉眼动脉段动脉瘤的临床特点及显微手术的治疗方法.方法 回顾性分析我院2006年12月至2010年9月40例颈内动脉眼动脉段动脉瘤患者的临床资料.男13例,女27例,其中合并前交通动脉瘤1例,双侧颈内动脉眼动脉段动脉瘤4例,合并后交通动脉瘤4例,合并小脑后下动脉瘤1例,合并大脑中动脉瘤1例,合并基底动脉瘤1例.结果 按GOS评分评定手术患者预后,恢复良好33例,轻度残疾1例,重度残疾2例,死亡4例；术后随访2 - 46个月(平均21.3个月),行头颅CTA或DSA检查证实动脉瘤夹闭完全.结论 经翼点入路夹闭颈内动脉眼动脉段动脉瘤是一种安全有效的方法.应根据患者术前Hunt - Hess分级以及动脉瘤的部位、大小、形态和医院的设备条件,选择个体化的治疗方法,术前完善影像学检查及手术过程中应用微血管多普勒对减少术后并发症及改善预后有重要意义.%Objective To explore the clinical characteristics and microsurgery for carotid artery aneurysms in the ophthalmic segment.Method Retrospectively analyzed the clinical data of 40 cases with carotid artery aneurysms in the ophthalmic segment from December 2006 to September 2010.There were 13 male cases and 27 female cases.Among them,1 case was associated with anterior communicating aneurysm,4 cases with bilateral carotid artery aneurysms of the ophthalmic segment,4 cases associated with internal carotid - posterior communicating artery aneurysm,1 case associated with posterior inferior cerebellar artery aneurysm,1 case associated with MCA aneurysm,1 case associated with basilar artery aneurysm.Results Prognosis of surgical patients was evaluated according to GOS rating,restored good in 33 cases,middle disabled in 1 case,severely disabled in 2 cases,died in 4 cases.The postoperative follow - up time was 2 to 46 months (mean 21.3 months),and all aneurysms were totally clipped that confirmed by CTA or DSA examination.Conclusions Carotid - ophthalmic aneurysm clipping by pterional approach is a safe and effective method.Individual treatment strategies should be applied to each patients according to the aneurysm location,size,shape,preoperational Hunt - Hess Grade,and the condition of the hospital.Comprehensive preoperative imaging examinations and the application of microvascular Doppler(MVD) during the operation have important significance for reducing postoperative complications and improving prognosis.