Kachhara Rajneesh, Nair Suresh, Nigam Pulak
Department of Neurosurgery, Institute of Neurosciences, Medanta Multi-speciality Hospital, Indore, Madhya Pradesh, India.
Sree Chitra Tirunal Institute of Medical Sciences & Technology, Trivandrum, India.
J Neurosci Rural Pract. 2021 Sep 30;12(4):635-641. doi: 10.1055/s-0041-1734002. eCollection 2021 Oct.
Surgical treatment of ophthalmic segment aneurysms (OSAs) remain challenging because of complex anatomy surrounding the aneurysm and entails extensive drilling of anterior clinoid process to define proximal neck of the aneurysm and carotid exposure in the neck for proximal control. Authors present a retrospective analysis of 36 aneurysms in 35 patients with OSAs operated surgically by first author. Surgical clipping was done for the aneurysms as primary modality of treatment along with wrapping and trapping as required. Commonest age group was 40 to 60 years with female preponderance of 3:1. Maximum (23) patients presented with subarachnoid hemorrhage (WFNS Gr 1), followed by asymptomatic patients (six). There were 18 small, 14 large, and four giant aneurysms, 15 dorsal wall, 17 ventral wall, three proximal posterior wall, and one blister aneurysm. Good outcome, as measured by Glasgow Outcome Score (GOS) was achieved in 29 patients. OSAs are technically demanding aneurysms, but with due diligence to surgical principles, good outcomes may be obtained.
由于动脉瘤周围解剖结构复杂，眼动脉段动脉瘤（OSA）的手术治疗仍然具有挑战性，需要广泛磨除前床突以明确动脉瘤的近端颈部，并暴露颈部的颈动脉以进行近端控制。作者对第一作者手术治疗的35例OSA患者的36个动脉瘤进行了回顾性分析。对动脉瘤进行手术夹闭作为主要治疗方式，并根据需要进行包裹和圈套。最常见的年龄组为40至60岁，女性占比为3:1。最多（23例）患者表现为蛛网膜下腔出血（WFNS 1级），其次是无症状患者（6例）。有18个小动脉瘤、14个大动脉瘤和4个巨大动脉瘤，15个位于后壁、17个位于前壁、3个位于近端后壁和1个水泡状动脉瘤。29例患者根据格拉斯哥预后评分（GOS）获得了良好的预后。OSA在技术上是要求很高的动脉瘤，但只要严格遵循手术原则，就可能获得良好的预后。
