眼眶出现症状性夹层性眼动脉瘤的血管内治疗:说明性病例。

Kohei Izumihara, Jun Haruma, Kenji Sugiu, Fukiko Baba, Juntaro Fujita, Yuichi Hirata, Yuta Sotome, Masato Kawakami, Ryu Kimura, Masafumi Hiramatsu, Shota Tanaka
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引用次数: 0

摘要

背景:眼外动脉动脉瘤(POAAs)起源于眼动脉主干或分支是非常罕见的。然而,他们的流行病学和最佳管理仍然知之甚少。作者报告了一例罕见的由动脉剥离引起的症状性POAA,并成功地使用血管内治疗,导致良好的视力恢复。观察:一位77岁的女性表现为右眼突发性视力障碍。眼科检查发现右视野有缺损。CT血管造影显示右眼眶内一梭状动脉瘤。数字减影血管造影显示珍珠和串状征象,符合夹层动脉瘤。球囊闭塞试验(BTO)证实颈外动脉侧支循环。在全身麻醉下进行OphA的内部捕获。术后患者视力逐渐改善,3个月内完全恢复。经验教训:虽然POAAs非常罕见,但由于视神经压迫,它们可能导致严重的视觉功能障碍。当出现视觉症状时,及时干预可能会逆转症状。术前使用BTO评估侧枝循环对治疗计划至关重要。当确认有足够的侧支流时,内部圈闭可能是有效的策略。https://thejns.org/doi/10.3171/CASE25483。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endovascular treatment for a symptomatic dissecting ophthalmic artery aneurysm occurring in the orbit: illustrative case.

Background: Peripheral ophthalmic artery aneurysms (POAAs) arising from the main trunk or branches of the ophthalmic artery (OphA) are extremely rare. However, their epidemiology and optimal management remain poorly understood. The authors report a rare case of a symptomatic POAA caused by arterial dissection that was successfully treated using endovascular therapy, leading to favorable visual recovery.

Observations: A 77-year-old woman presented with sudden-onset visual impairment in the right eye. Ophthalmological examination revealed a defect in the right visual field. CT angiography revealed a fusiform aneurysm in the right intraorbital OphA. Digital subtraction angiography revealed a pearl and string sign, consistent with a dissecting aneurysm. A balloon test occlusion (BTO) of the OphA origin confirmed collateral circulation from the external carotid artery. Internal trapping of the OphA was performed under general anesthesia. Postoperatively, the patient's visual function gradually improved, and complete recovery was achieved within 3 months.

Lessons: Although POAAs are exceptionally rare, they may lead to significant visual dysfunction owing to optic nerve compression. When visual symptoms are present, prompt intervention may reverse the symptoms. Preoperative assessment of collateral circulation using BTO is essential for treatment planning. Internal trapping may be an effective strategy when sufficient collateral flow is confirmed. https://thejns.org/doi/10.3171/CASE25483.

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