42例伴有动眼神经麻痹的后交通动脉瘤行介入栓塞及手术夹闭对神经麻痹的疗效分析

发布时间：2018-08-15 19:41

【摘要】：目的:探讨伴有动眼神经麻痹的后交通动脉瘤行介入栓塞及手术夹闭治疗对动眼神经麻痹的疗效及其影响因素。方法:对我院2012年1月至2016年9月间收治的42例伴有单侧动眼神经麻痹后交通动脉瘤病人的临床资料进行回顾性分析。其中开颅夹闭组13例,介入栓塞组29例,对不同治疗方式、术前动眼神经麻痹程度、术前是否伴发自发性蛛网膜下腔出血、动脉瘤大小以及治疗时间窗等可能影响动眼神经麻痹疗效的相关因素进行比较分析。结果:1、开颅夹闭组中13例病人,入院时有自发性蛛网膜下腔出血11例,无自发性蛛网膜下腔2例;术前动眼神经部分麻痹4例,完全麻痹9例;动脉瘤在左侧5例,右侧7例,双侧1例(左麻痹);动脉瘤瘤径7mm 4例,≤7 mm 9例;治疗时间窗7天4例,≤7天9例。2、介入栓塞组中29例病人,入院时有自发性蛛网膜下腔出血20例,无自发性蛛网膜下腔9例;术前动眼神经部分麻痹13例,完全麻痹16例;动脉瘤在左侧17例,右侧7例,双侧5例(左麻痹3右麻痹2);动脉瘤瘤径7 mm 11例,≤7 mm 18例;治疗时间窗7天8例,≤7天21例。3、随访结果:1)开颅夹闭组:术前动眼神经部分麻痹4例,随访时完全恢复3例,部分恢复0例,无恢复1例;术前动眼神经完全麻痹9例,随访时完全恢复5例,部分恢复3例,无恢复1例。改良Rankin评分0分12例,1分1例。2)介入栓塞组:术前动眼神经部分麻痹13例,随访时完全恢复8例,部分恢复4例,无恢复1例;术前动眼神经完全麻痹16例,随访时完全恢复4例,部分恢复5例,无恢复7例。改良Rankin评分0分26例,1分2例,2分1例。结论:开颅夹闭术和介入栓塞治疗伴有动眼神经麻痹后交通动脉瘤均能有效改善术后动眼神经麻痹症状,但开颅夹闭术似乎可较有效的促进术后动眼神经麻痹的恢复。在影响术后动眼神经麻痹恢复的诸多因素中,术前动眼神经部分麻痹、伴发自发性蛛网膜下腔出血者较易获得恢复,但术后动眼神经麻痹的恢复受多因素的影响,需要大宗双盲试验综合评估。
[Abstract]:Objective: to investigate the effect of interventional embolization and surgical clipping on oculomotor palsy with oculomotor nerve palsy. Methods: the clinical data of 42 patients with communicating artery aneurysm associated with unilateral oculomotor palsy from January 2012 to September 2016 were retrospectively analyzed. There were 13 cases in craniotomy clipping group and 29 cases in interventional embolization group. For different treatment methods, the degree of oculomotor nerve paralysis before operation, whether or not spontaneous subarachnoid hemorrhage occurred before operation, The size of aneurysm and the time window of treatment may influence the curative effect of oculomotor nerve palsy. Results of the 13 patients in the craniotomy clipping group, 11 had spontaneous subarachnoid hemorrhage, 2 had no spontaneous subarachnoid hemorrhage, 4 had partial oculomotor paralysis and 9 had complete paralysis, 5 had aneurysms on the left and 7 on the right. Bilateral 1 case (left paralysis), aneurysm diameter 7mm 4 cases, 鈮，

本文编号：2185209