Parameters for contralateral approach to ophthalmic segment aneurysms of the internal carotid artery
Parameters for contralateral approach to ophthalmic segment aneurysms of the internal carotid artery
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DOI：
10.1097/00006123-200011000-00022
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发表时间：
2000-11-01
期刊：
影响因子：
4.8
通讯作者：
Kobayashi, S
中科院分区：
文献类型：
--
作者：
Kakizawa, Y;Tanaka, Y;Kobayashi, S
目的：目的：探讨经对侧翼点入路治疗颈内动脉眼段动脉瘤的可行性及适应证。方法：1995 ~ 1999年，对46例颈内动脉眼段动脉瘤患者进行手术治疗。46个动脉瘤中的11个使用对侧翼点入路手术。所有动脉瘤均成功夹闭，无并发症; 3例患者需要切除动脉瘤颈周围的骨。我们对11例采用对侧入路治疗的患者进行了研究，定义了6个参数来评估该入路的可行性和预测骨切除的必要性：1）参数A，视交叉前方与利姆布斯缘之间的距离; 2）参数BI，视神经管入口处两侧视神经之间的距离; 3）参数C，视神经与伊卡的相互关系，表示为a/B，其中a为中线至视神经的长度，B为中线至伊卡的长度，4）参数D，动脉瘤瘤颈的大小，5）参数E，前后位血管造影上动脉瘤相对于伊卡壁的方向;参数F，在侧位血管造影片上从估计的远端硬脑膜环的内侧到近端动脉瘤颈的距离。参数A至F为8.8 mm（范围，5.4-11.1 mm），14.5 mm 9 mm（范围，0.6-1.3 mm）和3.0 mm（范围，2.3-4.7 mm）、5至160度和1.3 mm（范围，0.3-2.4 mm）。所有患者手术效果良好，无视力障碍。3例患者需要在开颅侧视神经管周围钻孔;当参数E在30 - 160度之间且参数F大于1 mm时，不需要钻孔。结论：参数A至D对于评估ICA眼段动脉瘤对侧入路的可行性非常重要，而参数E和F对于计算这种方法的难度是最有用的。
OBJECTIVE: This study was undertaken to define move accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA).METHODS: Between 1995 and 1999, 46 patients with ophthalmic segment aneurysms of the ICA were surgically treated in our institution. Eleven of the 46 aneurysms were operated using the contralateral pterional approach. AII aneurysms were successfully clipped without complications; three patients required bone resection around the aneurysm neck. We studied the 11 patients who were treated with the contralateral approach by defining six parameters to assess the feasibility of the approach and to predict the necessity for bone resection: 1) Parameter A, the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale; 2) Parameter BI the distance between the bilateral optic nerves at the entrance to the optic canal; 3) Parameter C, the interrelation of the optic nerve and the ICA, expressed as a/b in which a is the length from the midline to the optic nerve and b is the length from the midline to the ICA; 4) Parameter D, the size of the aneurysm neck; 5) Parameter E, the direction of the aneurysm from the ICA wall on the anteroposterior angiogram; and 6) Parameter F, the distance from the medial side of the estimated distal dural ring to the proximal aneurysm neck on the lateral angiogram.RESULTS: Parameters A to F were 8.8 mm (range, 5.4-11.1 mm), 14.5 mm (range, 10.4-22.2 mm), 0.9 mm (range, 0.6-1.3 mm), and 3.0 mm (range, 2.3-4.7 mm), 5 to 160 degrees, and 1.3 mm (range, 0.3-2.4 mm), respectively. All patients had excellent operative outcomes without visual dysfunction. Three patients required drilling of the bone around the optic canal on the craniotomy side; bone drilling was not required when Parameter E was between 30 and 160 degrees and Parameter F was more than 1 mm.CONCLUSION: Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.