颈内动脉眼动脉段动脉瘤手术治疗分析

目的 探讨颈内动脉眼动脉段动脉瘤（OSAs）的手术治疗方法及其疗效。方法 回顾性分析2005年8月至2015年12月年收治的88例OSAs的临床资料。88例共109枚动脉瘤。无眼部症状的48例69枚小型动脉瘤中,支架辅助弹簧圈栓塞49枚,单纯弹簧圈栓塞20枚;无眼部症状的17例单发大型或巨大动脉瘤中,球囊辅助栓塞2例,支架辅助栓塞13例,球囊联合支架辅助栓塞2例;合并视力障碍的23例（均为单发动脉瘤,小型动脉瘤12枚,大型或巨大型动脉瘤11枚）,12例栓塞,11例行动脉瘤夹闭术。结果 栓塞治疗的98枚动脉瘤术后即刻造影示,致密栓塞87枚,瘤颈部分显影11枚。88例术后平均随访18个月,术后6个月DSA或CTA随访,致密栓塞的47枚小型动脉瘤中,复发2枚（4.2%）;17例大型或巨大型动脉瘤中,复发5例（29.4%）。合并视力障碍的23例中,术后眼部症状改善13例（栓塞6例,夹闭7例）,未见明显变化6例（栓塞3例,夹闭3例）,加重4例（栓塞3例,夹闭1例）。结论 血管内栓塞治疗OSAs微创、安全、有效,但对改善视力障碍而言,夹闭术可能优于栓塞术。

Clinical analysis of effects of different surgical forms on internal carotid artery ophthalmic segment aneurysms

Objective To investigate the clinical effects of different operative forms on ophthalmic segment aneurysms (OSAs). Methods The clinical data of 88 patients with 109 OSAs including with 57 unruptured OSAs and 31 with ruptured OSAs, who were treated in Renji Hospital from August, 2005 to December, 2015, were analyzed respectively. Of 88 patients with 109 OSAs, 77 with 98 OSAs were treated by endovascular embolization, and 11 with 11 OSAs by microsurgical clipping. All the patients were followed up with MRA or CTA or DSA and received the assessment of prognosis with modified Rankin scale (mRS) 3, 6 and 12 months after the operation. The improvements of ophthalmic symptoms were followed up 3, 6 and 12 after the operations in the patients with visual deficit caused by OSAs. Results Of 69 small OSAs in 65 patients without ophthalmic symptoms, 49 received stent-assisted coiling embolization and 20 only by coiling embolization. OSAs recurred in 2 (3.1%) aneurysms during the following-up. Of 17 large or giant OSAs in 17 of these 65 patients without ophthalmic symptoms, 2 were treated by balloon-assisted coiling embolization, 13 by stent-assisted coiling embolization, and 2 by balloon combined with stent-assisted coiling embolization. OSAs recurred in 5 (29.4%, 5/17) during the following-up. Of 23 patients with visual deficit caused by OSAs including 12 patients with small OSAs and 11 patients with large or giant OSAs, 12 were treated by interventional embolization, and 11 by microsurgical clipping of OSAs. The following-up after the operation showed that the ophthalmic symptoms were improved in 6, unchanged in 3 and worsen in 3 of 12 patients with visual deficit undergoing the interventional embolization. The ophthalmic symptoms were improved in 7, unchanged in 3 and worsen in 1 of 11 patients with visual deficit undergoing the microsurgical clipping during the following up. Conclusions The endovascular embolization is a minimally-invasive, safe, and effective method to treat OSAs, but the microsurgical clipping is superior in the improvement of visual deficit to interventional embolization in the patients with OSAs.