【摘要】：目的:探討伴有動眼神經(jīng)麻痹的后交通動脈瘤行介入栓塞及手術(shù)夾閉治療對動眼神經(jīng)麻痹的療效及其影響因素。方法:對我院2012年1月至2016年9月間收治的42例伴有單側(cè)動眼神經(jīng)麻痹后交通動脈瘤病人的臨床資料進行回顧性分析。其中開顱夾閉組13例,介入栓塞組29例,對不同治療方式、術(shù)前動眼神經(jīng)麻痹程度、術(shù)前是否伴發(fā)自發(fā)性蛛網(wǎng)膜下腔出血、動脈瘤大小以及治療時間窗等可能影響動眼神經(jīng)麻痹療效的相關(guān)因素進行比較分析。結(jié)果:1、開顱夾閉組中13例病人,入院時有自發(fā)性蛛網(wǎng)膜下腔出血11例,無自發(fā)性蛛網(wǎng)膜下腔2例;術(shù)前動眼神經(jīng)部分麻痹4例,完全麻痹9例;動脈瘤在左側(cè)5例,右側(cè)7例,雙側(cè)1例(左麻痹);動脈瘤瘤徑7mm 4例,≤7 mm 9例;治療時間窗7天4例,≤7天9例。2、介入栓塞組中29例病人,入院時有自發(fā)性蛛網(wǎng)膜下腔出血20例,無自發(fā)性蛛網(wǎng)膜下腔9例;術(shù)前動眼神經(jīng)部分麻痹13例,完全麻痹16例;動脈瘤在左側(cè)17例,右側(cè)7例,雙側(cè)5例(左麻痹3右麻痹2);動脈瘤瘤徑7 mm 11例,≤7 mm 18例;治療時間窗7天8例,≤7天21例。3、隨訪結(jié)果:1)開顱夾閉組:術(shù)前動眼神經(jīng)部分麻痹4例,隨訪時完全恢復(fù)3例,部分恢復(fù)0例,無恢復(fù)1例;術(shù)前動眼神經(jīng)完全麻痹9例,隨訪時完全恢復(fù)5例,部分恢復(fù)3例,無恢復(fù)1例。改良Rankin評分0分12例,1分1例。2)介入栓塞組:術(shù)前動眼神經(jīng)部分麻痹13例,隨訪時完全恢復(fù)8例,部分恢復(fù)4例,無恢復(fù)1例;術(shù)前動眼神經(jīng)完全麻痹16例,隨訪時完全恢復(fù)4例,部分恢復(fù)5例,無恢復(fù)7例。改良Rankin評分0分26例,1分2例,2分1例。結(jié)論:開顱夾閉術(shù)和介入栓塞治療伴有動眼神經(jīng)麻痹后交通動脈瘤均能有效改善術(shù)后動眼神經(jīng)麻痹癥狀,但開顱夾閉術(shù)似乎可較有效的促進術(shù)后動眼神經(jīng)麻痹的恢復(fù)。在影響術(shù)后動眼神經(jīng)麻痹恢復(fù)的諸多因素中,術(shù)前動眼神經(jīng)部分麻痹、伴發(fā)自發(fā)性蛛網(wǎng)膜下腔出血者較易獲得恢復(fù),但術(shù)后動眼神經(jīng)麻痹的恢復(fù)受多因素的影響,需要大宗雙盲試驗綜合評估。
[Abstract]:Objective: to investigate the effect of interventional embolization and surgical clipping on oculomotor palsy with oculomotor nerve palsy. Methods: the clinical data of 42 patients with communicating artery aneurysm associated with unilateral oculomotor palsy from January 2012 to September 2016 were retrospectively analyzed. There were 13 cases in craniotomy clipping group and 29 cases in interventional embolization group. For different treatment methods, the degree of oculomotor nerve paralysis before operation, whether or not spontaneous subarachnoid hemorrhage occurred before operation, The size of aneurysm and the time window of treatment may influence the curative effect of oculomotor nerve palsy. Results of the 13 patients in the craniotomy clipping group, 11 had spontaneous subarachnoid hemorrhage, 2 had no spontaneous subarachnoid hemorrhage, 4 had partial oculomotor paralysis and 9 had complete paralysis, 5 had aneurysms on the left and 7 on the right. Bilateral 1 case (left paralysis), aneurysm diameter 7mm 4 cases, 鈮，

本文編號：2185209