Koskela Elina, Setälä Kirsi, Kivisaari Riku, Hernesniemi Juha, Laakso Aki
Department of Ophthalmology, Division of Neuro-Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
Department of Ophthalmology, Division of Neuro-Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
World Neurosurg. 2015 Apr;83(4):614-9. doi: 10.1016/j.wneu.2014.12.017. Epub 2014 Dec 18.
To assess prospectively neuro-ophthalmic findings associated with unruptured intracranial aneurysms and treatment morbidity and to identify factors predicting these findings.
Patients admitted to Helsinki University Central Hospital and treated surgically or endovascularly during 2011 underwent a neuro-ophthalmic examination, including formal visual field testing, before operation, at discharge, and 2-4 months and ≥6 months postoperatively. Univariate and multivariate analysis was used to identify factors predicting eye movement disorders.
Study participants included 142 patients with 184 treated aneurysms: 7 (5%) had a third, fourth, or sixth nerve palsy or skew deviation preoperatively, and 16 (11%) had a third, fourth, or sixth nerve palsy or skew deviation postoperatively; the frequency was 8 (6%) at the last follow-up evaluation. Other findings included compressive optic neuropathy (n = 4), ischemic optic neuropathy (n = 1), Weber syndrome (n = 3), Benedikt syndrome (n = 1), and Wallenberg syndrome (n = 1). Of the 140 survivors at 6 months, 7 (5%) presented with visual field defects resulting from the aneurysm or its treatment. In the best bivariate model, factors independently predicting postoperative eye movement disorders were aneurysm location in the posterior circulation with an odds ratio of 142.02 (95% confidence interval = 20.13-1002.22) and aneurysm size (odds ratio = 1.28 for each 1-mm increase in diameter, 95% confidence interval = 1.12-1.47).
Management of unruptured intracranial aneurysms is fairly safe from a neuro-ophthalmic perspective, with some treatment-related morbidity being transient and minor. Although rare, an irreversible deficit is possible and should be taken into account when considering preventive treatment.
前瞻性评估与未破裂颅内动脉瘤相关的神经眼科表现及治疗并发症，并确定预测这些表现的因素。
2011年入住赫尔辛基大学中心医院并接受手术或血管内治疗的患者，在术前、出院时、术后2 - 4个月和≥6个月接受了神经眼科检查，包括正规视野测试。采用单因素和多因素分析确定预测眼球运动障碍的因素。
研究参与者包括142例患者，共治疗184个动脉瘤：7例（5%）术前有动眼神经、滑车神经或展神经麻痹或斜视，16例（11%）术后有动眼神经、滑车神经或展神经麻痹或斜视；在最后一次随访评估时，发生率为8例（6%）。其他表现包括压迫性视神经病变（4例）、缺血性视神经病变（1例）、韦伯综合征（3例）、贝内迪克特综合征（1例）和瓦伦贝格综合征（1例）。在6个月时存活的140例患者中，7例（5%）出现由动脉瘤或其治疗导致的视野缺损。在最佳二元模型中，独立预测术后眼球运动障碍的因素为后循环动脉瘤位置，比值比为142.02（95%置信区间 = 20.13 - 1002.22）以及动脉瘤大小（直径每增加1毫米，比值比 = 1.28，95%置信区间 = 1.12 - 1.47）。
从未破裂颅内动脉瘤的神经眼科角度来看，其治疗相当安全，一些与治疗相关的并发症是短暂且轻微的。虽然罕见，但不可逆的缺陷是可能的，在考虑预防性治疗时应予以考虑。
