眼动脉段大型动脉瘤夹闭和载瘤动脉重建手术技巧的探讨  

Investigation the skills for giant ophthalmic artery aneurysm clipping and parent artery reconstruction

作　　者：叶明[1] 张鸿祺[1] 李萌[1] 鲍遇海[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2011年第6期287-291,297,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：北京市"十百千"卫生人才培养专项经费资助(京卫人字[2008]21号)

摘　　要：目的探讨对眼动脉段大型动脉瘤夹闭、载瘤动脉重建的手术技术和疗效。方法回顾性总结22例患者25个眼动脉段大型和巨大型动脉瘤的手术经验。手术方式为预先暴露颈总动脉分叉部,以备术中临时阻断颈内动脉及术中经颈内动脉穿刺逆向抽吸动脉瘤减压。手术均采用翼点入路,利用硬膜外或硬膜内入路磨除前床突,显露动脉瘤、载瘤动脉及其分支。术中采用超声多普勒检查动脉瘤夹闭、载瘤动脉重建后,患侧大脑中动脉M1段血流速度的变化。结果术后6个月随访发现:①术前表现头痛的8例患者,症状减轻7例、无变化1例;2例术前表现为头晕的患者,症状减轻1例、无明显改善1例;8例术前存在视力降低、视野缺损的患者,其中术后早期出现视力下降的2例患者,随访视力无改善;3例术后早期视力轻微改善的患者,视力进一步改善;3例术后早期视力无明显变化的患者中,2例晚期轻微改善,1例晚期仍无改善。②所有病例术后早期均行脑血管造影复查,其中有2个动脉瘤术后部分残余;2支载瘤动脉狭窄的患者术后均无神经功能障碍;1例患者术后出现对侧肢体偏瘫,肌力Ⅲ级,术后2周出院时,肌力恢复至Ⅳ级,术后6个月随访时肌力恢复到正常。③全部患者出院时格拉斯哥预后评分为良好(4～5分)。随访时间6～18个月,随访的17例疗效良好。结论术前充分地评估临床状况、术野的良好显露、颈部颈动脉临时阻断技术的应用、术中对动脉瘤的有效减压及术中超声多普勒脑血流监测等技术的综合应用,能够提高眼动脉段大型动脉瘤夹闭以及载瘤动脉重建的成功率。Objective To investigate the skills and efficacy for giant ophthalmic artery aneurysm clipping and parent artery reconstruction.Methods The surgical experiences of 22 patients with 25 large and giant ophthalmic aneurysms were analyzed retrospectively.The carotid bifurcations were exposed first for intraoperative temporary occlusion of internal carotid artery and retrograde suction decompression of the aneurysms.Pterional approaches were used in all the cases.The anterior clinoidal process was resected via intradural or extradural approach,the aneurysm,the parent artery and its branch vessels were exposed. Retrograde suction was used for aneurysm decompression.Intraoperative ultrasonic Doppler was used to detect the changes of blood flow velocity of ipsilateral M1 segment after aneurysm clipping and reconstruction of the parent arteries.Results ①Of the 8 patients suffered from headache before the procedure,the symptoms in 7 patients were improved and 1 patient had no change after the procedure.Of the 2 patients showed dizziness before the procedure,1 patient improved and 1 did not have obvious improvement after the procedure.Of the 8 patients with preoperative decrease of visual acuity and visual field defect,2 showed worse of visual acuity in the early postoperative period,and they did not improved at 6-month after the pro- cedure;of the 3 patients with early visual improvement after the procedure improved further at 6-month follow -up;of the 3 patients without obvious improvement in early period,2 improved slightly in the later time and 1 had no improvement finally.②AU patients underwent early postoperative cerebral angiography,there were 2 patients had residual aneurysms after the procedure;two patients had parent arteries stenosis,but the patients had no postoperative neurological deficits.One patient had paralysis on the contralateral limbs after the procedure(muscle strength grade 3),and returned to grade 5 at discharge 2 weeks after the procedure, and then returned to normal after 6 months.③The GOS(4-

关 键 词：颅内动脉瘤 眼动脉 神经外科手术 脑血管重建术 

分 类 号：R739.41[医药卫生—肿瘤]