Macquarie Neurosurgery, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, Australia.
Neurosurg Rev. 2024 Sep 13;47(1):601. doi: 10.1007/s10143-024-02794-2.
Visual loss secondary to a vascular loop or atherosclerotic carotid has been a controversial topic for many years with contemporary data supporting its existence. The role of surgery in the management of this entity is not well defined. We performed a systematic review describing the different surgical techniques and outcomes.
A search strategy was devised in accordance with the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. An electronic search was performed from the databases Pubmed, Google scholar, Scopus and Web of Science databases. The search was performed from inception until the 10th of December 2023.
A total of 2469 articles were screened with 15 articles describing 18 patients being included. Of these cases, eleven involved compression due to unilateral or bilateral dolichoectatic internal carotid artery (ICA), three for a dolichoectatic anterior cerebral artery (ACA), two for a combination of a dolichoectatic ICA with a dorsolateral ophthalmic artery and two for a combination of a dolichoectatic ICA and ACA.
Two distinct compressive entities can be differentiated. Compressive optic neuropathy at the entrance of the optic canal due to pinching between an ectatic carotid and the falciform ligament. A second entity is due to compression of the cisternal optic nerve or chiasm secondary tot a vascular loop. A variety of surgical techniques have been described and include: unroofing of the optic canal with sectioning of the falciform ligament; microvascular decompression with a Teflon pellet, a muscle patch or, rerouting of the offending vessel with a sling. Larger and prospective studies are needed to better define the role of surgery in this, probably, underreported pathology.
血管环或粥样硬化性颈动脉引起的视力丧失多年来一直是一个有争议的话题，当代数据支持其存在。手术在这种情况下的作用尚未明确。我们进行了一项系统评价，描述了不同的手术技术和结果。
根据 2020 年系统评价和荟萃分析（PRISMA）报告的首选报告项目制定了搜索策略。从 Pubmed、Google Scholar、Scopus 和 Web of Science 数据库进行了电子检索。搜索从开始到 2023 年 12 月 10 日进行。
共筛选了 2469 篇文章，其中 15 篇文章描述了 18 例患者被纳入。这些病例中，11 例涉及单侧或双侧梭形扩张颈内动脉（ICA）压迫，3 例涉及梭形扩张大脑前动脉（ACA）压迫，2 例涉及梭形扩张 ICA 与眶外侧动脉结合，2 例涉及梭形扩张 ICA 与 ACA 结合。
可以区分两种不同的压迫实体。视神经管入口处的压迫性视神经病变是由于扩张的颈动脉和镰状韧带之间的挤压引起的。第二种实体是由于血管环压迫颅底视神经或视交叉引起的。已经描述了多种手术技术，包括：视神经管开窗，镰状韧带切开；使用特氟龙球、肌肉贴片或吊索重新引导病变血管的微血管减压。需要更大规模和前瞻性的研究来更好地确定手术在这种可能被低估的病理学中的作用。
