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題名 | Recovery of Oculomotor Nerve Function after Surgical Intervention for Intracranial Aneurysms of the Internal Carotid Artery=顱內內頸動脈瘤之手術對動眼神經功能恢復的影響 |
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作者姓名(中文) | 沈炯祺; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 25:6 民81.11-12 |
頁次 | 頁1446-1455 |
分類號 | 416.74 |
關鍵詞 | 顱內內頸動脈瘤手術; 動眼神經功能恢復; |
語文 | 英文(English) |
中文摘要 | 顱內內頸動脈瘤無論是破裂出血或未出血,臨床上常引起動眼神經麻痺。而影響其功能恢復的因素很多,如手術時間、手術方式及術前麻痺的程度。吾人回溯過去七年間(1983-1989),臺中榮民總醫院有五十位這種動脈瘤的病患,當中十五位合併動眼神經麻痺。其中二位術前以部份麻痺表現,一個月後直接以動脈瘤夾子住動脈瘤,其動眼神經功能仍然完全恢復。另外十三位病患術前以動眼神經完全麻痺表現:當中五位在二個星期內直接以動脈瘤夾子夾住動脈瘤,其動眼神經功能都完全恢復。另外八位在二個星期後手術,五位直接以動脈瘤夾子夾住動脈瘤,三位以淺顳動脈一中大腦動脈(STA-MCA)吻合手術,動眼神經功能只部份恢復,而且有四位產生雜亂再生(Aberrent Regeneration),而二位在海綿竇之巨大動脈瘤在動眼神經麻痺後二年才接受淺顳動脈一中大腦動脈吻合手術,其動眼神經仍然完全麻痺。在動眼神經功能部份恢復合併雜亂再生的病人常引起視覺不方便,如眼球活動不自然、複視,造成日常生活的不便。因此及早(二週內)以直接動脈瘤夾子夾住動脈瘤不但能預防致命性動脈瘤的破裂,而且能使動眼神經功能完全恢復。 |
英文摘要 | Fifteen patients with intracranial aneurysms of internal carotid artery (ICA) who presented with oculomotor nerve palsy were operated on between January 1983 and December 1989. Five of 13 complete palsy patients who were operated on within two weeks showed complete recovery. Partial recovery was found in six patients with late operation (over two weeks). Aberrent regeneration of the nerve was found in four cases, the most frequent sign was Pseudo-Graefe's phenomenon. Permerment oculomotor nerve palsy after operation was found in two cases, because of difficulty in direct clipping of the giant aneurysms. Two patients with incomplete oculomotor nerve palsy had complete recovery, even after a late operation (over one month). Therefore, early clipping of the aneurysm usually leads to an excellent recovery of oculomotor nerve function, even in cases with complete palsy, and complete recovery was also found in patients with partial palsy even after late operation. We recommend that early, direct clipping of intracranial ICA aneurysm is critically important for the prevention of massive bleeding and the better recovery of oculomotor nerve function. |
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