显微外科治疗颈内动脉-眼动脉瘤  

Microsurgical treatment of carotid ophthalmic aneurysms.

作　　者：王凡[1] 刘盛明[1] 蔡俊杰[1] 吴虹[1] 侯敏[1] 

机构地区：[1]成都市第三人民医院神经外科,四川成都610031

出　　处：《四川医学》2010年第10期1453-1454,共2页Sichuan Medical Journal

摘　　要：目的探讨颈内动脉-眼动脉瘤的临床特点和手术策略。方法回顾性分析14例颈内动脉-眼动脉瘤的临床和随访资料。所有患者均进行了CT和/或CTA及3D-DSA检查证实。手术采用标准翼点入路,首先暴露颈部颈内动脉以备临时阻断。从硬脑膜内外磨除上眶壁、蝶骨嵴和前床突,分离外侧裂,临时阻断载瘤动脉,无血状态下完全分离显露并夹闭瘤颈。结果 14例术后复查CTA显示动脉瘤完全夹闭。预后良好12例,差2例,没有死亡患者。晚期随访10例,随访时间2年,均无神经功能废损。结论根据影像学资料进行手术前规划非常关键,显微神经外科技术是治疗颈内动脉-眼动脉瘤并降低病死率的保证。Objective To explore the clinical features and microsurgical strategies of carotid ophthalmic aneurysms（COA）.Methods Clinical datas and follow-up outcomes of fourteen COA patients were reviewed.Neuroimaging included CT and/or CTA,3D-DSA.The standard pterional approach was performed.Firstly,proximal ICA control was obtained through routine exposure of the cervical ICA prior to craniotomy and the ICA was isolated by a rubber loop.Then,parts of the superior orbital wall,sphenoid ridge and the anterior clinoid process were drilled off using the epidural and subdural approach.Wide splitting of the Sylvian fissure allows easier brain retraction.For providing a large space and dissection the neck of aneurysm,the parent artery was temporarily occluded.Subsequently,mobilization of the optic nerve and ICA allowed access to the aneurysm for clipping.Results Postoperative outcome was evaluated for two years after microsurgery.All aneurysms were completely obliterated without either recurrence or death.Conclusion Preoperative planning based on neuroimaging is very valuable.Microneurosurgical techniques are optimal for the management of COA ever lessening morbidity.

关 键 词：颈内动脉-眼动脉瘤 显微外科手术治疗 

分 类 号：R651.1[医药卫生—外科学]