Dolenc V V
J Neurosurg. 1985 May;62(5):667-72. doi: 10.3171/jns.1985.62.5.0667.
A series of 14 patients with a carotid-ophthalmic artery aneurysm were treated operatively. In five patients the aneurysms were large, but only one of these had ruptured; four of these patients had symptoms of mass lesions. The remaining nine patients were operated on for a ruptured aneurysm; seven had subarachnoid hemorrhage due to the carotid-ophthalmic artery aneurysm and two had bleeding from another aneurysm in the presence of an asymptomatic carotid-ophthalmic artery aneurysm. All patients were treated by a combined epi- and subdural direct surgical approach, which excluded the carotid-ophthalmic artery aneurysm from the circulation and made possible the preservation of the adjacent structures. Two patients died: one a few hours after surgery from a massive thromboembolism of the pulmonary artery and another 2 months after surgery as a result of gastrointestinal bleeding. All the other patients showed postoperative improvement in symptoms and signs. This report focuses on a modified direct surgical approach involving exposure of the internal carotid artery proximal to the lesion, and of the ophthalmic artery, which is of primary importance in securing safe and complete occlusion of a carotid-ophthalmic artery aneurysm. Removal of individual bone structures at the base of the skull provides a better and safer exposure of the central segment of the internal carotid artery than does excessive and hazardous retraction of the brain.
对14例颈眼动脉动脉瘤患者进行了手术治疗。其中5例动脉瘤较大，但仅1例发生破裂；这5例患者中有4例有占位性病变症状。其余9例患者因动脉瘤破裂接受手术；7例因颈眼动脉动脉瘤导致蛛网膜下腔出血，2例在无症状颈眼动脉动脉瘤存在的情况下因另一动脉瘤出血。所有患者均采用硬膜外和硬膜下联合直接手术方法治疗，该方法将颈眼动脉动脉瘤排除在循环之外，并有可能保留相邻结构。2例患者死亡：1例在术后数小时死于肺动脉大量血栓栓塞，另1例在术后2个月死于胃肠道出血。所有其他患者术后症状和体征均有改善。本报告重点介绍一种改良的直接手术方法，该方法包括暴露病变近端的颈内动脉以及眼动脉，这对于安全、完全闭塞颈眼动脉动脉瘤至关重要。与过度且危险地牵拉脑组织相比，去除颅底的个别骨结构能更好、更安全地暴露颈内动脉中央段。
