Woodall M Neil, Alleyne Cargill H
The Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
The Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
World Neurosurg. 2017 Aug;104:372-375. doi: 10.1016/j.wneu.2017.05.034. Epub 2017 May 16.
Several recent reports have implicated vascular ectasia and vessel contact in dysfunction of the visual apparatus. A subset of patients with prechiasmatic visual deterioration have an ectatic internal carotid artery (ICA) that displaces and flattens the optic nerve (ON) rostrally as the ON exits the skull base. We describe a proposed pathophysiologic mechanism and a straightforward surgical technique for dealing with this problem.
Via an ipsilateral pterional craniotomy, the bony roof of the optic canal is removed. The falciform ligament is opened in parallel to the ON. Adhesions between the ICA and ON are then dissected, and a Teflon pledget is placed between the ICA and ON to complete the decompression.
Patients both in the literature and in this series experienced an improvement in their vision postoperatively.
We propose that 3 mechanisms contribute to this caroticofalciform optic neuropathy: 1) mass effect from ICA ectasia, 2) ON irritation from vessel pulsatility, and 3) indirect compression by the falciform ligament from above. This disease process can be treated safely using standard microsurgical techniques with excellent outcomes.
最近的几份报告表明，血管扩张和血管接触与视觉器官功能障碍有关。一部分视交叉前视觉功能恶化的患者存在颈内动脉（ICA）扩张，当视神经（ON）离开颅底时，扩张的颈内动脉会将视神经向前移位并使其变平。我们描述了一种针对该问题的病理生理机制及一种简单的手术技术。
通过同侧翼点开颅术，去除视神经管的骨顶。沿视神经平行切开镰状韧带。然后解剖颈内动脉与视神经之间的粘连，并在颈内动脉与视神经之间放置一块特氟龙棉片以完成减压。
文献及本系列中的患者术后视力均有改善。
我们认为有三种机制导致这种颈动脉 - 镰状韧带性视神经病变：1）颈内动脉扩张的占位效应；2）血管搏动对视神经的刺激；3）镰状韧带从上方向下的间接压迫。使用标准显微外科技术可以安全地治疗这一疾病过程，且效果良好。
