经Dolenc入路显微手术治疗颈内动脉眼动脉段动脉瘤的疗效观察

Observation of the therapeutic effect of clipping aneurysm in the ophthalmic artery segment of internal carotid artery via the Dolenc approach

目的观察经Dolenc入路显微手术治疗颈内动脉(ICA)眼动脉段动脉瘤的临床疗效。方法回顾性分析2017年6月至2020年1月南京医科大学附属脑科医院神经外科采用显微手术治疗的ICA眼动脉段动脉瘤患者,共32例(38个动脉瘤)。24例患者为未破裂动脉瘤,8例为破裂动脉瘤(Hunt-Hess分级Ⅰ级5例,Ⅱ级1例,Ⅲ级1例,Ⅳ级1例)。患者均采用经Dolenc入路夹闭ICA眼动脉段动脉瘤,根据动脉瘤的分型采用不同的手术策略。观察患者的手术相关并发症,并随访临床预后。结果32例患者均成功夹闭ICA眼动脉段动脉瘤,术中荧光造影证实夹闭的动脉瘤均未显影,载瘤动脉及穿支血管通畅。术后1周头颅CT血管成像或数字减影血管造影检查证实动脉瘤夹闭完全,无载瘤动脉狭窄。5例(15.6%)发生手术相关并发症。其中术中静脉性出血1例,去骨瓣减压术后6个月一侧肢体肌力为Ⅳ级;术后出现同侧视力下降2例,1例未恢复,1例恢复;动眼神经麻痹2例,3个月后均恢复良好。32例患者的临床随访时间为(19.6±6.4)个月(3~32个月),无一例患者出现因脑积水而需要行脑脊液分流手术。末次随访格拉斯哥预后评级Ⅴ级29例,Ⅳ级2例,Ⅲ分级1例。31例(96.9%)患者术后12个月的影像学随访均未见动脉瘤复发。结论经Dolenc入路夹闭ICA眼动脉段动脉瘤的疗效确切,严重手术并发症的发生率低。

Objective To observe the clinical efficacy of surgical clipping of aneurysm in the ophthalmic artery segment of internal carotid artery(ICA)via Dolenc approach.Methods A retrospective analysis was conducted on the clinical data of 32 patients(38 aneurysms)with ICA ophthalmic artery segment aneurysms surgically treated at the Department of Neurosurgery,the Affiliated Brain Hospital of Nanjing Medical University from June 2017 to January 2020.Among them,24 patients had unruptured aneurysms,and 8 had ruptured aneurysms(5 cases of Hunt-Hess gradeⅠ,1 case of gradeⅡ,1 case of gradeⅢ,and 1 case of gradeⅣ).All patients were treated with trans-Dolenc approach to clip the ophthalmic artery segment aneurysms using different surgical strategies depending on the types of aneurysms.The patients were observed for surgery-related complications and followed up for clinical outcomes.Results All 32 patients successfully underwent the aneurysm clipping.Intraoperative fluoroscopy confirmed that the aneurysm was not visualized,and the parent artery and perforating vessels were unobstructed.A cranial contrast examination 1 week postoperatively confirmed that the aneurysm was completely clipped and there was no stenosis of parent artery.Five patients(15.6%)developed surgery-related complications.Among them,there were 1 case of intraoperative venous hemorrhage,2 cases of ipsilateral vision loss after surgery out of which 1 case did not recover and 1 recovered,and 2 cases of oculomotor nerve palsy which recovered well after 3 months.The clinical follow-up period of 32 patients was 19.6±6.4 months(3 to 32 months),and none of the patients had the need for cerebrospinal fluid shunting surgery due to hydrocephalus.At the last follow-up based on Glasgow outcome scale,there were 29 cases of gradeⅤ,2 cases of gradeⅣ,and 1 case of gradeⅢ.Angiography of 31 patients(96.9%)performed at 12 months after surgery showed that none of the aneurysms had recurred.Conclusion Surgical clipping of aneurysm in the ophthalmic artery segment of ICA via the Dolenc approach is associated with few complications and definite efficacy.