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目的探讨颅内动脉瘤与其眼部表现的规律。设计回顾性病例系列。研究对象91例颅内动脉瘤患者。方法回顾2005年1月至2007年12月解放军总医院神经外科收治的颅内动脉瘤患者的病历。具有眼部症状的患者均进行脑血管数字减影检查,施行手术或介入治疗。主要指标颅内动脉瘤位置、大小以及瘤顶指向和不同程度的眼科症状。结果91例颅内动脉瘤患者中合并眼部表现者23例(25.27%)。其中后交通动脉瘤12例(52.17%),颈内动脉岩段及颈内动脉床突旁段动脉瘤各2例(8.70%),颈内动脉眼动脉段、大脑前动脉、大脑中动脉、小脑后下动脉、海绵窦段、颈动脉原始三叉动脉、颈内动脉分叉处动脉瘤各1例(4.35%)。后交通动脉瘤的眼部症状以程度不同的动眼神经麻痹为主。床突旁段、颈动脉原始三叉动脉、颈内动脉岩段动脉瘤患者分别出现视力下降、外展神经麻痹及发作性复视。患者术前皆未进行详细的眼科检查。术后最长随访1年,动脉瘤栓塞术后患者皆未出现眼部症状改善,瘤颈夹闭术后患者眼部症状改变有限或无改善。结论半数的伴有眼部表现的颅内动脉瘤为后交通动脉瘤,以动眼神经麻痹为眼部主要表现。颅内动脉瘤患者应及时进行眼科会诊。
Objective To study the rules of intracranial aneurysms and their ocular manifestations. Design retrospective case series. 91 cases of patients with intracranial aneurysms. Methods The medical records of patients with intracranial aneurysms admitted to the Department of Neurosurgery, PLA General Hospital from January 2005 to December 2007 were retrospectively reviewed. Patients with ocular symptoms underwent cerebrovascular digital subtraction examinations, surgery or interventional therapy. The main indicators of intracranial aneurysm location, size and tumor dome pointing and varying degrees of ophthalmic symptoms. Results Of the 91 patients with intracranial aneurysm, 23 had ocular surface manifestations (25.27%). There were 12 cases (52.17%) of posterior communicating aneurysm, 2 cases (8.70%) of internal carotid artery and internal carotid artery anterior segment of aneurysm, 2 cases of internal carotid arterial segment, anterior cerebral artery, middle cerebral artery, The posterior inferior cerebellar artery, the cavernous sinus segment, the primary trigeminal artery of the carotid artery, and the aneurysm of the internal carotid artery bifurcation each had 1 case (4.35%). Ocular symptoms of post-traffic artery aneurysms with varying degrees of oculomotor palsy-based. Abnormalities of visual acuity, abducens nerve paralysis and episodes of diplopia were observed in patients with aneurysm of bed segment, carotid original trigeminal artery and internal carotid artery. Patients have not conducted a detailed eye examination before surgery. The longest follow-up of 1 year after surgery, aneurysm embolization in patients with no improvement in ocular symptoms, ocular neck after clipping patients with limited or no improvement in eye symptoms. Conclusions Half of the intracranial aneurysms with ocular manifestations are posterior communicating aneurysms and oculomotor nerve paralysis is the major manifestation of the eye. Patients with intracranial aneurysm should be timely ophthalmic consultation.