【摘要】：目的研究眼動脈及其周圍組織結構的解剖間隙和解剖關系,探討其眼動脈解剖應用在頸內動脈眼動脈段動脈瘤的顯微手術治療中的手術技巧、應對策略和療效觀察。方法選擇20具成人國人尸頭,共40側,做眼動脈的灌注和解剖,進行觀察和測量,研究其眼動脈的周圍組織結構及其解剖關系。以單人單中心回顧性研究的方法納入青大附院神經外科由豐育功教授主刀完成的自1996年10月至2015年12月之間經翼點入路行顱內眼動脈動脈瘤夾閉術的病人共計42例,占所有在此時間內由術者所行顱內動脈瘤夾閉術的患者的2.7%。觀察和統(tǒng)計42例頸內動脈眼動脈段動脈瘤患者的基本資料、手術治療和術后療效等相關臨床資料,對相關顯微手術治療策略進行探討。結果42例頸內動脈眼動脈段動脈瘤患者中,總計44個頸內動脈眼動脈段動脈瘤,全部經過開顱手術夾閉治療。術中在分離和暴露動脈瘤過程中未發(fā)生破裂的動脈瘤計數41個,占總數的93.2%,發(fā)生破裂的動脈瘤計數3個,占總數的6.8%。33例眼動脈段動脈瘤患者術后未出現相應并發(fā)癥,其中共2例患者因ICA閉塞而發(fā)生大面積腦梗死造成死亡,共計6例患者術后視力未改善(包括術前已經存在視力障礙或喪失的患者),有1例患者術后發(fā)生硬膜外血腫造成二次手術。根據格拉斯哥預后分級(Glasgow Outcome Scale,GOS)將研究組內42例患者的動脈瘤顯微手術治療預后分為四級:Ⅳ級(治愈,無遺留相關神經功能障礙,完全恢復正常工作和生活),共計39例,占總體的92.8%;Ⅲ級(自理,指有輕微的神經功能障礙,但日常的生活能自理),共計數1例,占總體的2.4%;無Ⅱ級(有重度的神經功能障礙,正常生活不能自理)病人;Ⅰ級(死亡),共計數2例,占頸內動脈眼動脈段動脈瘤患者總體的4.8%。結論頸內動脈眼動脈的發(fā)出與眼動脈瘤的解剖位置密切相關,掌握眼動脈及周圍解剖是頸內動脈眼動脈段動脈瘤顯微手術治療、獲得良好治療效果的基礎,可以有效的減少誤損傷和并發(fā)癥的發(fā)生。在處理大動脈瘤和復雜動脈瘤時,根據病人的個體差異,根據需要行頸內動脈的解剖或瘤體臨時阻斷,在眼動脈瘤的減壓、阻斷和夾閉中有較好效果。在磨除前床突的過程中,選擇規(guī)格合適的磨頭,減少和消除在磨除視神經管骨質的過程中高速磨鉆產生的熱量,封堵開放的氣房,可以有效降低磨除骨質的過程中高速磨鉆產生的熱損傷并減少腦脊液漏等并發(fā)癥的發(fā)生。
[Abstract]:Aim to study the anatomic space and anatomic relationship of the ophthalmic artery and its surrounding tissue structure, and to explore the operative techniques, coping strategies and therapeutic effects of the ophthalmic artery anatomy in the microsurgical treatment of the aneurysm of the ophthalmic artery segment of the internal carotid artery. Methods Twenty adult Chinese cadaveric heads (40 sides) were used to observe and measure the perfusion and anatomy of the ophthalmic artery to study the surrounding tissue structure and anatomic relationship of the ophthalmic artery. A single, single-center retrospective study was performed in the neurosurgery department of the affiliated Hospital of Qingda University. From October 1996 to December 2015, a total of 42 patients underwent intracranial ophthalmic aneurysm closure via the pterygoid approach from October 1996 to December 2015, with a total of 42 cases of neurosurgery performed by Professor Fengyukong. It accounted for 2.7% of all patients who underwent intracranial aneurysm clamping at this time. The clinical data of 42 patients with aneurysm of the internal carotid artery segment of the ophthalmic artery were observed and counted, and the related clinical data, such as surgical treatment and postoperative curative effect, were observed and counted, and the strategies of microsurgical treatment were discussed. Results A total of 44 aneurysms of the ophthalmic segment of the internal carotid artery were treated by craniotomy in 42 patients with aneurysms of the segment of the ophthalmic artery of the internal carotid artery. During the operation, 41 aneurysms (93.2%) were not ruptured during the separation and exposure of aneurysms, and the number of ruptured aneurysms was 3. 33 patients with ophthalmic artery aneurysm had no corresponding complications after operation, 2 of them died due to large area cerebral infarction due to ICA occlusion. A total of 6 patients had no improvement in postoperative visual acuity (including those who had visual impairment or loss before operation), and one patient had postoperative epidural hematoma resulting in secondary surgery. According to Glasgow Prognostic grading (Glasgow Outcome Scale,GOS), the microsurgical treatment of aneurysm in 42 patients in the study group was divided into four grades: grade 鈪，

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