颅底动脉瘤的眼部改变

Ophthalmological findings in patients with intracraneal aneurysms in the base of skull

目的 :探讨颅底动脉瘤的早期眼部改变 ,避免误诊。方法 :回顾性对 3 0例颅底动脉瘤的眼部改变进行分析。结果 :临床表现有 4组 :①单纯颅神经受压症状 6例。②自发性颈动脉海绵窦瘘 5例。③轻度蛛网膜下腔出血伴有颅神经受压症状 6例。④蛛网膜下腔出血为主者 4例。总计颅神经受压症状中 ,动眼神经麻痹 16只眼 ( 5 3 % ) ,外展神经麻痹 11只眼( 3 7% ) ,三叉神经麻痹 11只眼 ( 3 7% ) ,视神经受损导致的视力减退 9只眼 ( 3 0 % ) ,视神经萎缩 5只眼 ( 17% ) ,视乳头水肿 2只眼 ( 7% )。结论 :中年以上原因不明的明显头痛伴有动眼神经等颅神经障碍者 ,自发性颈动脉海绵窦瘘者应警惕到颅底动脉瘤的可能。

Objective:To discuss the earlier detection of eye signs in patients with intracranial aneurysms in the base of skull. Methods:Eye sings in 30 cases of aneurysms in the bsse of skull were retrospectively. Results:Clinical menifestations could be divided into 4 groups:6 cases with the symptoms due to cranial nerve compression merely;5 cases with the symptoms due to spontaneous carotid artery cavernous sinus fistula;6 cases with the symptoms due to slightly subarachnoid hemorrhage accompanied by cranial nerve compression; 4 cases with the symptoms due to subarachnoid hemorrhage mainly.In total,oculomotor plasy was found in 16 eyes(53%),abducens nerve palsy in 11 eyes(37%),trigeminal nerve palsy in 11 eyes(37%),optic nerve damage induced hypopsia in 9 eyes(30%),optic atrophy in 5 eyes(17%),papilledema in 2 eyes(7%). Conclusions:Intracranial aneurysms in the base of skull should be considered in middle-aged patients who complained of cause unknown heavy headache,accompanied by cranial nerve disorders,such as oculomotor palsy,spontaneous carotid artery cavernous sinus fistula,etc.