颈内动脉眼动脉段动脉瘤的显微外科手术治疗

Microsurgical treatment of ophthalmic segment artery aneurysms

目的探讨颈内动脉眼动脉段动脉瘤(OSAs)的显微外科手术技术及方法。方法回顾性分析四川省医学科学院·四川省人民医院神经外科自2010年6月至2020年6月收治的23例OSAs患者的治疗方法及结果,其中头痛10例、视力下降及视野缺损7例、月经紊乱1例、无症状5例。23例患者检共出动脉瘤32个,有11例患者为多发动脉瘤,其中6例为双侧动脉瘤(4例为双侧OSAs);破裂动脉瘤者5例。23个OSAs直径范围4~30 mm,平均(8.2±2.3)mm,巨大动脉瘤2例。采用硬膜外入路或硬膜下入路,磨除前床突,颈部切口显露颈内动脉辅助术中阻断,夹闭困难采用颅内外搭桥技术。统计患者预后情况,分析显微手术夹闭治疗OSAs的效果。结果23例OSAs患者中17例进行颈部颈动脉临时阻断,13例采用硬膜外入路(未破裂动脉瘤),8例采用硬膜下入路(包括5例破裂动脉瘤),2例患者中1例颅内外搭桥动脉瘤孤立、1例颈内动脉近端阻断。21例患者恢复良好,9例头痛者症状消除,6例视力下降及视野缺损者好转,1例月经紊乱者术后好转。随访2~63个月,复发2例(8.7%),并发脑积水3例。术后3个月GOS评分:5分20例,4分2例,3分1例,无死亡病例。结论熟练的显微神经外科手术技术是OSAs治疗的关键。OSAs的显微外科手术夹闭治疗安全,效果满意。

Objective To explore the microsurgical techniques and methods of the treatment of ophthalmic segment artery aneurysms(OSAs).Methods The treatment methods and results of 23 cases of OSAs,admitted to Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital from June 2010 to June 2020,were retrospectively analyzed.There were 10 cases of headache,7 cases of decreased vision and visual field defect,1 case of menstrual disorder,and 5 cases of asymptomatic.A total of 32 aneurysms were detected in 23 patients,11 of them were multiple aneurysms,including 6 bilateral aneurysms(4 bilateral OSAs),and 5 ruptured aneurysms.OSAs were 4-30 mm in diameter,with an average of(8.2±2.3)mm.There were 2 cases of giant aneurysms.Epidural approach or intradural approach were applied for the anterior clinoidectomy.The neck incision revealed the internal carotid artery to assist with intraoperative occlusion.Intracranial and extracranial bypass techniques were used in condition of unable clipping.Results In 23 cases of OSAs,17 cases with cervical carotid artery temporarily blocked,13 cases used the epidural approach and 8 cases used the subdural approach(with 5 cases of ruptured aneurysms),giant OSAs in 2 cases accepted intracranial and extracranial bypass,1 aneurysm was trapping and another was treated with carotid artery ligation.Twenty-one cases recovered well,symptoms of 9 cases of headache were eliminated,6 cases of vision decreased and visual field defect improved,and 1 case of menstrual disorder improved after surgery.Follow-up was 2-63 months,2 cases(8.7%)recurred,3 cases were complicated with hydrocephalus.Three months after surgery,the GOS 5 scores were achieved in 20 cases,4 scores in 2 cases,3 scores in 1 case and no deaths.Conclusion Experienced micro-neurosurgical technique is the key to the treatment of ophthalmic segment artery aneurysms.The microsurgical clipping of OSAs is safe and effective.