颅内动脉瘤与动眼神经麻痹的相关性分析

Analysis of correlation between intracranial aneurysms and oculomotor nerve paralysis

目的比较伴发动眼神经麻痹(OMNP)与非动眼神经麻痹(NOMNP)的颅内动脉(IA)瘤患者在各临床因素之间的差异性,并为其诊断及治疗提供依据。方法收集本院神经内科及神经外科2014年1月至2016年12月连续入组的224例经DSA确诊的单侧单发IA患者的临床资料,记录以下因素:性别、年龄、首发症状、受累眼肌表现、动脉瘤部位及最大直径、是否伴发蛛网膜下隙出血(SAH)、手术方式及预后等。对IA的部位进行统计,并将其中的后交通动脉瘤按照其首发症状分为动眼神经麻痹(OMNP)组及非动眼神经麻痹(NOMNP)组,分析两组之间的差异性。结果 (1)对动脉瘤部位分析统计可知,后交通动脉(74例,33.0%)最常见;(2)NOMNP组患者发生SAH的概率(84.91%)要明显高于OMNP组(19.05%)。结论以动眼神经麻痹为首发症状的患者,需排除动脉瘤的存在。对于继发于后交通动脉瘤的动眼神经麻痹患者,给予及时的干预措施,可预防动脉瘤破裂并改善预后。

Objective To analyze and compare the differences of clinical factors between patients with oculomotor nerve palsy and without oculomotor nerve palsy, and to provide evidence for the diagnosis and treatment of intracranial aneurysms （ IA ）. Methods Collect the clinical data of two hundred and twenty four patients with unilateral single IA diagnosed by DSA in the Affiliated Xinhua Hospital of Shanghai Jiaotong University School of Medicine Department of Neurology and Department of Neurosurgery from January 2014 to December 2016, and the following factors were recorded： Sex, age, onset symptoms, involvement of ocular muscle performance, aneurysm site and the largest diameter, whether associated with subaraehnoid hemorrhage （ SAH ） , surgical methods and prognosis. The location of intracranial aneurysms was statistically analyzed and the patients with posterior communicating aneurysms were divided into two groups according to their first symptom： Oculomotor nerve palsy （ OMNP ） group and Non-oculomotor nerve palsy （ NOMNP ） group. Compare the differences between the two groups. Results （1） Analytic statistics of the site of the IA shows that that the posterior communicating artery （ n=74,33% ） was the most common position; （2） The probability of occurrence of SAH in the NOMNP group （ 84.91% ） was significantly higher than that in the OMNP group （ 19.05% ） . Conclusion Patients with oculomotor nerve palsy as the first symptom need to exclude the existence of aneurysms. For patients with oculomotor nerve palsy secondary to posterior communicating aneurysms, timely intervention can prevent rupture of the aneurysm and improve the prognosis.