DSA在孤立性动眼神经麻痹的临床应用研究

DSA study of isolated oculomotor nerve paresis

目的 评价DSA在确诊孤立性动眼神经麻痹 (isolatedoculomotornerveparesis ,IONP)中的意义和作用。方法 搜集临床怀疑颅内动脉瘤而行全脑血管造影的 13 82例 ,其中以孤立性动眼神经麻痹为主诉者 14 8例 ,均于造影前行CT检查 ,3 7例已行MRA检查。结果 14 8例在DSA检查中 ,诊断为动脉瘤者 10 9例 ,其中发生在后交通动脉 99例 ,颈内动脉C4 段 5例 ,C3段 2例 ,虹吸部C2 ,3段巨大动脉瘤 1例 ,小脑后上动脉 2例。动脉瘤形态呈囊状 10 4例 ,梭形膨大 5例。 3例双侧后交通动脉瘤 ,均为一侧动眼神经麻痹 ,而另一侧则无症状 ,2例颈内动脉C4 段动脉瘤行载瘤动脉栓塞减压术后动眼神经麻痹得以恢复。 3 7例行MRA检查 ,全部显示动脉瘤。CTA检查 18例中有 12例显示为后交通动脉瘤。结论 孤立性动眼神经麻痹的病人 ,应行DSA检查 ,以确定有无颅内动脉瘤的存在 ,而利于治疗方法的选择 ,达到除外动脉瘤消除症状的目的。

Objective To evaluate the value and effect of DSA in diagnosing isolated oculomotor nerve paresis. Methods One thousand three hundred and eighty-two cases clinical suspected encephalic aneurysm underwent DSA, 148 cases performed CT before DSA, 37 cases underwent MRI. Results One hundred and nine in 148 cases were diagnosed as aneurysm by DSA. Among them, 99 cases located in posterior communicating artery;5 cases in C 4, 3 cases in C 3 of internal carotid artery;2 cases in posterior superior cerebellar artery,respectively. Round and fusiform aneurysms were found in 104 cases and 5 cases respectively. Oculomotor nerve paresis in one side could be found in three patients with aneurysms in bilateral posterior communicating arteries. Oculomotor nerve paresis recovered in two cases with aneurysm in the internal carotid artery's C 4 segment after a decompressed operation by embolizing aneurysms. Thirty-seven cases performed MRA and the aneurysms were found in all the cases; 18 cases underwent CTA, and aneurysms in posterior communicating artery were found in 12 cases. Conclusion In order to choose the best treatment as well as to eliminate patients' symptoms, DSA should be employed in patients with isolated oculomotor nerve paresis to determine the existence of encephalic aneurysm.