合并眼部症状的颅内动脉瘤临床分析  

Clinical analysis of intracranial aneurysm with ophthalmic changes

作　　者：于涛[1] 程美仙[2] 林瑞生[1] 

机构地区：[1]福建医科大学附属漳州市医院神经外科,363000 [2]福建医科大学附属漳州市医院眼科,363000

出　　处：《临床神经外科杂志》2015年第1期28-31,共4页Journal of Clinical Neurosurgery

摘　　要：目的探讨合并眼部症状的颅内动脉瘤的临床特点和治疗效果。方法回顾性分析我科近四年间收治的73例合并眼部症状的颅内动脉瘤病例。所有患者均经DSA或CTA检查明确诊断后施行动脉瘤瘤颈夹闭手术或介入栓塞治疗,重点分析动脉瘤的位置、大小及瘤顶指向与眼部症状的关系,随访观察术后眼部症状改善情况。结果 73例合并眼部症状的动脉瘤患者中表现为颅神经麻痹58例,视力下降37例,眼痛34例,视野改变9例,眼底改变11例。43例经动脉瘤颈夹闭手术治疗的患者,术后症状消失或有较大程度改善的24例,占55.8%。30例经介入栓塞治疗的患者,术后症状消失或有较大程度改善8例,占26.7%。动脉瘤瘤颈夹闭手术治疗组眼部症状疗效优于介入栓塞治疗组(P<0.01)。结论近半数颅内动脉瘤伴有眼部临床表现,其中以颈内动脉海绵窦段、眼动脉段和后交通动脉段动脉瘤最多见。眼部症状以动眼神经麻痹最为常见,及时发现以眼部表现为首发症状的动脉瘤,对改善患者预后意义重大。就眼部症状治疗效果而言,动脉瘤瘤颈夹闭手术优于介入栓塞治疗。Objective To investigate the clinical characteristics and prognosis of intracranial aneurysm with ophthalmic changes .Methods The clinical data of 73 patients with intracranial aneurysm caused ophthalmic changes in our hospital within recent four years were analyzed retrospectively .All patients were diagnosed by digital subtraction angiography （ DSA ） or computed tomography angiography （CTA） and treated by microsurgical clipping or interventional embolization . Different locations sizes of aneurysms and pointing of its tips , situation of ophthalmic changes were analyzed .The improvement of ophthalmic changes after operation were followed up .Results 73 patients （44.5%） had ophthalmic changes in 164 patients.58 patients suffered from cranial nerve palsy, visual diminished in 37 cases, 34 patients had eyeball and orbital pain , 11 cases had fundus changes and 9 cases had visual field defects .43 patients with ophthalmic changes were treated by microsurgical clipping , 24 patients showed complete or partly recovery after operation （55.8%）.30 patients with ophthalmic changes were treated by interventional embolization , only 8 showed complete or partly recovery after operation （ 26.7%）. Microsurgical clipping treatment was superior to interventional embolization for the improvement of ophthalmic changes .Conclusions Half of intracranial aneurysms patients had ophthalmic changes , and the oculomotor nerve palsy was the most common change .Early diagnosis and treatment can make better outcome .Microsurgical clipping treatment is superior to interventional embolization for the improvement of ophthalmic changes .

关 键 词：颅内动脉瘤 眼科症状 颅神经麻痹 治疗 

分 类 号：R739.41[医药卫生—肿瘤]