• 江油市人民醫(yī)院神經(jīng)外科(四川江油,621700);

【摘要】 目的  探討伴有動眼神經(jīng)麻痹的后交通動脈瘤的顯微手術(shù)治療效果。 方法  回顧性分析2008年1月—2010年12月采用顯微外科手術(shù)治療的伴隨動眼神經(jīng)麻痹的后交通動脈瘤患者52例的臨床資料,觀察動眼神經(jīng)麻痹的恢復(fù)情況,總結(jié)臨床經(jīng)驗。術(shù)后隨訪時間3~36個月,平均16個月。 結(jié)果  發(fā)病至手術(shù)時間 lt;14 d患者34例,22例(64.7%)完全恢復(fù),12例(35.3%)部分恢復(fù)。 gt;14 d者18例,6例(32.3%)完全恢復(fù),12例(67.7%)不完全恢復(fù)。不完全性麻痹15例,12例(80.0%)完全恢復(fù),3例(20.0%)得到改善;而術(shù)前完全動眼神經(jīng)麻痹的37例中,僅11例(29. 7% )徹底恢復(fù)、26例(70. 3% )部分恢復(fù)。 結(jié)論  早期明確診斷及盡早手術(shù)治療,對于伴隨有動眼神經(jīng)麻痹的后交通動脈瘤患者的神經(jīng)功能恢復(fù)極為重要。
【Abstract】 Objective  To explore the curative effect of microsurgical treatment for posterior communicating artery aneurysms associated with oculomotor palsy. Methods  The clinical data of 52 patients with posterior communicating artery aneurysms associated with oculomotor palsy treated microsurgically from January 2008 to December 2010 were retrospectively analyzed. Recovery of oculomotor palsy was observed, and clinical experiences were summarized. Results  The follow-up time ranged from 3 to 36 months with a mean period of 16 months. Among the 34 patients operated on within 14 days after the onset of oculomotor palsy, 22 (64.7%) showed complete recovery, and 12 (35.3%) partial recovery. In the 18 patients operated on more than 14 days after the onset of the disease, 6 (32.3%) showed complete recovery, and 12 (67.7%) partial recovery. Incomplete palsy occurred in 15 patients among whom 12 (80%) had complete recovery and 3 (20%) alleviation. Among the other 38 patients with complete oculomotor palsy, only 11 (29.7%) got complete recovery, and the remaining 26 (70.3%) partial recovery. Conclusion  Early and positive diagnosis and treatment of patients with posterior communicating artery aneurysms associated with oculomotor palsy is of great importance to the nerve function recovery.

引用本文: 胡永光. 伴有動眼神經(jīng)麻痹的后交通動脈瘤的手術(shù)治療. 華西醫(yī)學(xué), 2011, 26(6): 882-884. doi: 復(fù)制

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1.  Brisman JL, Song JK, Newell DW, et al. Cerebral Aneurysms[J]. N Engl J Med, 2006, 355(9): 928 -939.
2.  Hanse MC, Gerrits MC, van Rooij WJ, et al. Recovery of posterior communicating artery aneurysm induced oculomotor palsy after coiling [J]. AJNR Am J Neuroradiol, 2008, 29(5): 988-990.
3.  Mocco J, Ransom ER, Komotar RJ, et al. Preoperative prediction of long-termoutcome in poor-grade aneurismal subarachnoid hemorrhage[J]. Neurosurgery, 2006, 59 (3): 529-538.
4.  Leivo S, Hernesniemi J, Luukkonen M, et al. Early surgery improves the cure of aneurysm induced oculomotor palsy[J]. Surg Neurol, 1996, 45(5): 430-434.
5.  傅相平, 李安民, 張志文, 等. 動眼神經(jīng)麻痹與后交通動脈瘤[J]. 中國微侵襲神經(jīng)外科雜志, 2004, 9( 8): 368-369.
6.  江峰, 華續(xù)明, 張文川, 等. 單側(cè)性動眼神經(jīng)麻痹的臨床分析[J]. 中華神經(jīng)醫(yī)學(xué)雜志, 2004, 3(1): 35-36.
7.  TakahashiM, Kase M, Suzuki Y, et al. Incomplete oculomotor palsy with pupil sparing caused by compression of the oculomotor nerve by a posterior communicating posterior cerebral aneurysm[J]. Jpn J Ophthalmo, 2007, 51 (6): 470-473.
8.  張軍臣. 早期手術(shù)治療后交通動脈瘤能改善繼發(fā)性動眼神經(jīng)麻痹[J]. 國外醫(yī)學(xué)?腦血管疾病分冊, 1997, 5 (1): 56-57.
9.  楊明琪, 王碩, 趙繼宗. 不同方法治療后交通動脈瘤性動眼神經(jīng)麻痹的臨床分析[J].北京醫(yī)學(xué), 2007, 29 (8): 449-451.
10.  陳榮華, 宣井崗, 彭亞, 等. 后交通動脈瘤破裂致動眼神經(jīng)麻痹的血管內(nèi)治療[J]. 當(dāng)代醫(yī)學(xué), 2010, 15 (35): 666-667.
  1. 1.  Brisman JL, Song JK, Newell DW, et al. Cerebral Aneurysms[J]. N Engl J Med, 2006, 355(9): 928 -939.
  2. 2.  Hanse MC, Gerrits MC, van Rooij WJ, et al. Recovery of posterior communicating artery aneurysm induced oculomotor palsy after coiling [J]. AJNR Am J Neuroradiol, 2008, 29(5): 988-990.
  3. 3.  Mocco J, Ransom ER, Komotar RJ, et al. Preoperative prediction of long-termoutcome in poor-grade aneurismal subarachnoid hemorrhage[J]. Neurosurgery, 2006, 59 (3): 529-538.
  4. 4.  Leivo S, Hernesniemi J, Luukkonen M, et al. Early surgery improves the cure of aneurysm induced oculomotor palsy[J]. Surg Neurol, 1996, 45(5): 430-434.
  5. 5.  傅相平, 李安民, 張志文, 等. 動眼神經(jīng)麻痹與后交通動脈瘤[J]. 中國微侵襲神經(jīng)外科雜志, 2004, 9( 8): 368-369.
  6. 6.  江峰, 華續(xù)明, 張文川, 等. 單側(cè)性動眼神經(jīng)麻痹的臨床分析[J]. 中華神經(jīng)醫(yī)學(xué)雜志, 2004, 3(1): 35-36.
  7. 7.  TakahashiM, Kase M, Suzuki Y, et al. Incomplete oculomotor palsy with pupil sparing caused by compression of the oculomotor nerve by a posterior communicating posterior cerebral aneurysm[J]. Jpn J Ophthalmo, 2007, 51 (6): 470-473.
  8. 8.  張軍臣. 早期手術(shù)治療后交通動脈瘤能改善繼發(fā)性動眼神經(jīng)麻痹[J]. 國外醫(yī)學(xué)?腦血管疾病分冊, 1997, 5 (1): 56-57.
  9. 9.  楊明琪, 王碩, 趙繼宗. 不同方法治療后交通動脈瘤性動眼神經(jīng)麻痹的臨床分析[J].北京醫(yī)學(xué), 2007, 29 (8): 449-451.
  10. 10.  陳榮華, 宣井崗, 彭亞, 等. 后交通動脈瘤破裂致動眼神經(jīng)麻痹的血管內(nèi)治療[J]. 當(dāng)代醫(yī)學(xué), 2010, 15 (35): 666-667.