摘要
目的观察引起动眼神经麻痹的颅内未破裂动脉瘤经治疗后的临床转归。方法回顾性分析27例首都医科大学宣武医院自2005年1月—2009年7月诊治的引起动眼神经麻痹的颅内未破裂动脉瘤患者的临床资料。其中19例经血管内治疗,8例经开颅手术夹闭。观察动脉瘤的特征、治疗方法和临床转归。结果①后交通动脉动脉瘤15例,平均瘤径为(6.6±0.6)mm,颈内动脉颅内段其他部位动脉瘤12例,平均瘤径为(22.5±3.0)mm,两者比较差异有统计学意义(P<0.05)。②开颅手术治疗的8例中,术后动脉瘤完全闭塞7例,瘤颈残留1例;血管内治疗的19例中,动脉瘤完全闭塞16例,瘤颈残留3例。两组动脉瘤完全闭塞的比例和瘤颈残留的比例差异均无统计学意义。③行开颅手术治疗组有7例治愈,1例症状改善;血管内治疗组有17例治愈,2例症状改善。两组疗效差异无统计学意义(P>0.05)。27例患者症状消失和改善的时间为15 d至24个月。④26例患者获得6～48个月的随访,1例在随访3个月后失访。23例动脉瘤完全闭塞者无动脉瘤再通和再生长,4例瘤颈残余者瘤颈未再生长。1例术后出现并发症者,6个月时仅遗留有言语缓慢。结论引起动眼神经麻痹的颅内未破裂动脉瘤中,后交通动脉动脉瘤较颈内动脉颅内段其他部位引起动眼神经麻痹的动脉瘤瘤径小。对此类动脉瘤应给予积极治疗;手术和血管内治疗均可以达到满意的临床效果。
Objective To observe the surgical effect for unruptured intracranial aneurysm caused oculomotor nerve palsy. Methods Twenty-seven patients with unruptured intracranial aneurysms caused ocnlomotor nerve palsy were admitted and treated in Xuanwu Hospital, Capital Medical University from January 2005 to July 2009. Nineteen patients were treated with endovascular intervention and 8 were treated with surgical clipping. The aneurysmal characteristics, treatment strategies, and clinical outcome were observed. Results （1）Fifteen patients with posterior communicating artery aneurysms, the mean diameter of the aneurysms was 6.6 ± 0. 6 mm. Twelve patients with the intracranial internal carotid artery other location artery aneurysm, the mean diameter was 22. 5 ± 3.0 mm. There was statistical significance between the two groups （P 〈0.05）. （2）The aneurysm of 8 patients were treated with surgical clipping, seven were completely occluded after surgery, one had a residual aneurysm neck. The aneurysm of 19 patients were treated with interventional method, sixteen were completely obliterated, three had residual necks. （3）Of the patients treated with surgery, the symptoms of oculomotor nerve palsy in 7 patients disappeared completely and in one patient improved; Of the patients with interventional treatment, the symptoms disappeared completely in 17, and improved in one. There was no significant difference of therapeutic efficacy between the two groups（ P 〉 0.05 ）. The time period of symptom disappearance and improvement in 27 patients was 15 d to 24 months. （4） Twenty-six patients were followed up for 6 to 48 months ; one was lost to follow-up after 3 months. Twenty-three patients with completely occluded aneurysms did not had aneurysm recanalization and regrowth. The aneurysm necks did not enlarged in 4 patients with residual aneurysm neck. One patient had postoperative complications after the surgery, and his speech remained slow at 6 months. Conclusion The unruptured intracranial aneurysms affecting oculomotor nerve should be treated aggressively. Both microsurgery and interventional method can achieve satisfactory clinical effect.
出处
《中国脑血管病杂志》
CAS
2010年第11期570-573,共4页
Chinese Journal of Cerebrovascular Diseases
基金
北京市"十百千"卫生人才培养专项经费资助(京卫人字[2008]21号)
关键词
颅内动脉瘤
动眼神经
手术夹闭
血管内治疗
Intracranial aneurysm
Oeulomotor nerve
Surgical clipping
Endovascular intervention
