颈内动脉眼动脉段动脉瘤的手术治疗

目的探讨颈内动脉眼动脉段动脉瘤和床突间隙的解剖学特点及夹闭术技巧和预后。方法经翼点入路手术治疗颈内动脉眼动脉段动脉瘤患者共13例（13个动脉瘤），包裹2例（2个动脉瘤），术中采用颅内外颈内动脉临时阻断方法。结果手术后经DSA或CTA检查显示，13例患者动脉瘤夹闭满意，载瘤动脉和远端动脉血流通畅；2例视力障碍患者手术后视力改善。手术后仅1例出现对侧肢体轻度偏瘫，无一例发生手术相关严重并发症。随访3～10个月（平均5个月），均恢复良好。结论经翼点入路辅助颅内外颈内动脉临时阻断是治疗颈内动脉眼动脉段动脉瘤安全有效的手术方法。术中荧光造影可即时发现动脉瘤是否残留及载瘤动脉有无狭窄，从而指导手术医师调整动脉瘤夹位置而达到夹闭满意。

Surgical treatment of carotid- ophthalmic aneurysm

Objective To explore the anatomical features of carotid- ophthalmic aneurysm and clinoid process and the surgical technique and outcome. Methods In this study there were 15 patients with carotid-ophthalmic aneurysm （12 patients ophthalmic aneurysm, 1 superior hypophsial aneurysm, 2 dorsal internal carotid aneurysm）. Patients were treated by clipping procedure through pterional approach. During the procedure, intra- and extra-cranial internal carotid arteries were temporarily occluded. Results Postoperative digital subtraction angiography （DSA） or CT angiography （CTA） examinations showed that the effect of clipping treatment was satisfactory in 13 patients, the blood flow was good in parent artery and distal artery. Visual acuity was improved in 2 cases with visual disturbance. After surgery only one case presented hemiparesis of contralateral limb. No severe operative- related complications occurred. All patients were followed up for 3-10 months （average 5 months） after surgery. The recovery was good. Conclusion Pterional approach combined with temporary blocking of intra- and extra-cranial internal carotid artery is an effective and safety surgical method for treating carotid-ophthalmic aneurysm. During operation, fluorescence imaging can immediately indicate whether there are residual aneurysm and narrow parent artery, so that it can help the physician to adjust the clipping procedure and achieve satisfactory effect.