额外侧入路在微创治疗颈内动脉-眼动脉段动脉瘤手术中的应用  

Surgical management of ophthalmic artery aneurysms via minimally invasive frontolateral approach

作　　者：王建涛[1] 阚志生[1] 王硕[2] 

机构地区：[1]首都医科大学附属北京安贞医院神经外科,100029 [2]首都医科大学附属北京天坛医院神经外科

出　　处：《中华医学杂志》2017年第15期1179-1183,共5页National Medical Journal of China

摘　　要：目的探讨经额外侧入路手术治疗眼动脉瘤的手术技巧和预后。方法回顾性分析应用额外侧入路手术治疗的北京天坛医院神经外科和北京安贞医院神经外科共95例颈内动脉一眼动脉瘤患者的临床和随访资料。将动脉瘤进行分型，经额外侧入路手术。根据术前分型，总结手术特点及预后。结果95例患者根据其全脑数字减影血管造影结果分型，其中Ⅰ型44例（46．3％），Ⅱ型34例（35．7％），Ⅲ型17例（17．9％）。眼动脉瘤直径〈10mm（35例），10-25mm（34例），〉25mm（26例）。蛛网膜下腔出血17例病例中，破裂的眼动脉瘤共8例。手术夹闭93例，2例加固包裹，5例多发动脉瘤在同一入路下同时夹闭。术后动脉瘤无残留。术后3例患者同侧视力下降；9例出现脑梗死；余患者情况良好。结论经额外侧入路夹闭眼动脉段动脉瘤，显露充分，开颅过程简单，创伤小，术后效果好。适用于大多数眼动脉段动脉瘤。Objective To explore the minimally invasive techniques and outcome of carotid ophthalmic artery aneurysms clipping via a frontolateral approach. Methods The clinical data of 95 patients with carotid ophthalmic artery aneurysms treated via frontolateral approach in the last 1.5 years in Beijing Tiantan Hospital and Beijing Anzhen Hospital were analyzed retrospectively. Before the operation, digital subtraction angiogram （DSA） was performed among all patients. The patients were divided into two groups by the lateral approach. According to preoperative classification, surgical characteristics and prognosis were summarized. Results Ninety-five cases of ophthalmic aneurysms were divided into type Ⅰ of 44 cases （46. 3% ）, type Ⅱ of 34 cases （35.7%） and type Ⅲ of 17cases （ 17. 9% ）, according to the results of DSA. The diameter of aneurysm was 〈 10 mm （35 cases）, 10 -25 mm （34 cases）, and 〉25 mm （26 cases）. In the 17 cases of subarachnoid hemorrhage （SAH） , 8 cases were ruptured carotid-ophthalmic artery aneurysms. Among those 95 patients, 93 were clipped successfully, 2 was trapped. Multiple aneurysms in 5 cases were treated in one surgical session through the same approach. No aneurysm residual was found after postoperative CTA review. Ipsilateral vision of 3 cases were decline. Cerebral infarction was appeared in 9 cases. All the others had a good recovery. Conclusions The carotid-ophthalmic artery aneurysms could be well exposed. Microsurgery through frontolateral approach has the advantages such as minimal invasion, less effect on the patients＇ look and simple procedure. The frontolateral approach is safe and effective in surgery for ophthalmic segment of the internal carotid artery aneurysms.

关 键 词：微创 眼动脉瘤 夹闭 

分 类 号：R651.12[医药卫生—外科学]