Curative Observation Of Application Of Ophthalmic Artery Dissection To The Microsurgical Treatment Of Carotid Ophthalmic Aneurysms

Objective: To study the anatomical relationship and anatomical space of optic canal and its adjacent structures and to investigate the operating skill to manage optic canal,coping strategies and to observe the curative effect in the general microsurgical treatment of carotid ophthalmic aneurysms.Methods: ophthalmic arteries after perfusion were studied on adult cadaveric heads.In the single-center retrospective study,a total of 42 patients who had the microsurgery of carotid-ophthalmic aneurysms clipping via pterion approach between October,1996 and December,2015 were included in the study.All of the 42 patients accounted for 2.7% who had the microsurgery on clipping of intracranial aneurysms during the same time.By collecting the clinical basic information,surgicaldata and situations about postoperative functional recovery,we did a retrospective observation and evaluation of the 42 patients with carotid-ophthalmic aneurysms.Results: Totally,44 intracranial aneurysms were found in the 42 patients all of whom had received the treatment of intracranial aneurysms clipping.During the microsurgery of separation of aneurysms,41 aneurysms with non-ruptured accounted for 93.2% of all the 44 intracranial aneurysms.3 aneurysms with ruptured accounted for 6.8%.In perioperative period,33 patients developed brain swelling,but all of them had been cured or improved before discharge,while 2 patients died from massive cerebral infarction caused by internal carotid artery occlusion.6 patients didn't get visual improvement after microsurgery,which included those patients who had got decreased vision or vision loss before microsurgery;1 patient had second microsurgery due to epidural hematoma.According to Glasgow Outcome Scale,the prognoses of patients were classified into four degrees: ? degree(cured,and without related neuronal dysfunctions,completely resume normal work and life)in which patients numbered 39,accounting for 92.8% of the total 42 patients;? degree(self-care level,and with minor neurological dysfunctions)in which patients numbered 1,accounting for 2.4%;? degree(serious neurological dysfunctions,and without daily living ability)in which patients numbered zero;? degree(death)in which patients numbered 2,accounting for 4.8%.Conclusions: The close relationship between carotid-ophthalmic aneurysms' anatomical position and ophthalmic artery's original location was found by clinical analysis.During the microsurgery of carotid-ophthalmic aneurysms,to master the dissection of ophthalmic artery is key to get good therapeutic effect and minimize faulty operation and operative complications.When dealing with giant or large carotid-ophthalmic aneurysms,based on patient individual differences,opening up optic canal and proximal end of internal carotid artery make sense for the decompression,interruption and clipping of aneurysms.Furthermore,during the process of disclosure of optic canal,we need to choose appropriate specifications of drill grinder and simultaneously pay attention to reduce and eliminate the heat generated by high-speed burr in the process of drilling the bone of optic canal and to block the open air compartment which maybe exist in anterior clinoid process and optic strut which constitute optic canal,so as to minimize the thermal damage and reduce the possibility of developing cerebrospinal fluid leak.