眶上外侧入路治疗颈内动脉眼动脉段动脉瘤

Microsurgical management of ophthalmic segment aneurysm of internal carotid artery via lateral supraorbital approach

目的探讨经眶上外侧入路手术治疗颈内动脉眼动脉段动脉瘤的手术策略与疗效。方法回顾性分析24例颈内动脉眼动脉段动脉瘤病例资料,其中多发动脉瘤4例,共计28个动脉瘤。动脉瘤破裂致蛛网膜下腔出血12例。根据术前影像对动脉瘤进行分型:Ⅰ型12例,Ⅱ型4例,Ⅲ型8例。均经眶上外侧入路手术治疗。结果动脉瘤直径≤5 mm 3个,>5~15 mm16个,>15~25 mm 7个,>25 mm 2个。夹闭23例,加固包裹1例。术后同侧视力下降与动眼神经麻痹2例,同侧视野偏盲1例。出院时GOS 5分22例,4分1例,3分1例(术前壳核出血)。Ⅰ、Ⅱ型病人与Ⅲ型病人术后脑神经功能损害,差异具有统计学意义(P=0.028)。结论经眶上外侧入路治疗颈内动脉眼动脉段动脉瘤显露良好,开颅过程简便,创伤小,术后效果好。经眶上外侧入路适用于大多数颈内动脉眼动脉段动脉瘤。

Objective To explore the surgical strategy and effect of the sugery via lateral supraorbital approach for the ophthalmic segment aneurysm of internal carotid artery(ICA).Methods The clinical data of 24 patients with ophthalmic segment aneurysm of ICA,including 4 cases of multiple aneurysms,a total of 28 aneurysms,were analyzed retrospectively.The subarachnoid hemorrhage caused by aneurysm rupture occurred in 12 cases.The aneurysms were classified according to preoperative images:typeⅠin 12 cases,typeⅡin 4,and typeⅢin 8.The surgical treatment was performed via lateral supraorbital approach.Results The diameter of aneurysm was≤5 mm in 3 aneurysms,>5-15 mm in 16,>15-25 mm in 7 and>25 mm in 2.Among the 24 patients,23 were clipped successfully and 1 was trapped.Postoperative ipsilateral visual acuity decreased with oculomotor nerve paralysis occurred in 2 cases,and ipsilateral visual field hemianopia in 1.GOS 5 points were seen in 22 cases,4 points in 1,and 3 points in 1(due to preoperative putamen hemorrhage).There was a statistically significant difference in postoperative neurological impairment between typeⅠ,typeⅡpatients and typeⅢpatients(P=0.028).Conclusions The lateral supraorbital approach for the treatment of ophthalmic segment aneurysm of ICA is well exposed,the craniotomy is simple,the trauma is small,and the postoperative effect is good thus being suitable for most ophthalmic segment aneurysm of ICA.