Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Clin Neurosci. 2013 Aug;20(8):1145-8. doi: 10.1016/j.jocn.2012.11.005. Epub 2013 Feb 26.
Ophthalmic segment aneurysms refer to superior hypophyseal artery aneurysms, true ophthalmic artery aneurysms, and their dorsal variant. Indications for treatment of these aneurysms include concerning morphological features, large size, visual loss, or rupture. Although narrow-necked aneurysms are ideal endovascular targets, more complex and larger lesions necessitating adjunctive stent or flow-diversion techniques may be suitably treated with long-lasting, effective clip ligation instead. This is particularly relevant in the consideration of ruptured ophthalmic segment aneurysms. This article provides a depiction of microsurgical treatment of ophthalmic segment aneurysms with an accompanying video demonstration. Emphasis is placed on microsurgical anatomy, the intradural anterior clinoidectomy and clipping technique. The intradural anterior clinoidectomy, demonstrated in detail in our Supplementary video, provides significant added exposure of the ophthalmic segment of the internal carotid artery, allowing for improved aneurysm visualization. In the management of superior hypophyseal artery aneurysms, emphasis is placed on identifying and preserving superior hypophyseal artery perforators, using serial fenestrated straight clips rather than a single right-angled fenestrated clip to obliterate the aneurysm. Post-clipping indocyanine green dye angiography is a crucial tool to confirm aneurysm obliteration and the preservation of the parent vasculature and adjacent superior hypophyseal artery perforators. With careful attention to the nuances of microsurgical clipping of ophthalmic segment aneurysms, rewarding results can be obtained.
眼部节段动脉瘤是指垂体上动脉动脉瘤、真性眼动脉动脉瘤及其背侧变异。这些动脉瘤的治疗指征包括形态学特征、瘤体较大、视力丧失或破裂。尽管窄颈动脉瘤是理想的血管内治疗靶点，但对于更复杂和更大的病变，可能需要辅助支架或血流转向技术，而永久性、有效的夹闭结扎可能是更合适的治疗方法。这在考虑破裂的眼部节段动脉瘤时尤为重要。本文通过视频演示，介绍了眼部节段动脉瘤的显微手术治疗。重点介绍了显微手术解剖、硬脑膜内前床突切除术和夹闭技术。硬脑膜内前床突切除术在我们的补充视频中详细展示，可显著增加颈内动脉眼部段的显露，从而改善动脉瘤的可视化。在处理垂体上动脉动脉瘤时，重点是识别和保护垂体上动脉穿支，使用串联开窗直夹而不是单个直角开窗夹来闭塞动脉瘤。夹闭后吲哚菁绿染料血管造影是确认动脉瘤闭塞和保护载瘤血管及相邻垂体上动脉穿支的重要工具。通过仔细注意眼部节段动脉瘤的显微夹闭细节，可以获得满意的效果。
