Intracranial aneurysm is a common disease of intracranial vascular system, and its incidence rate ranks the third, second only to cerebral thrombosis and cerebral hemorrhage, and its potential danger is intracranial hemorrhage caused by rupture of the aneurysm, and the annual rupture and hemorrhage rate is 0.5% to 2%, and it is the first cause of spontaneous subarachnoid hemorrhage (SAH), which accounts for 80% of the total, and the mortality and disability rates are high. It is the first cause of SAH, accounting for 80% of cases, with a high mortality and disability rate, and is extremely harmful to society. Many cases have ocular changes, so this disease is also categorized under neuro-ophthalmology. Ophthalmic aneurysm is an aneurysm located between the ophthalmic artery and the posterior communicating artery, accounting for 0.47%~9.26% of all intracranial aneurysms. 30%~% of the patients manifested SAH, and 1/3 of them had visual function damage, such as visual acuity loss, visual field defects, and optic nerve atrophy, etc. In this paper, we will discuss the anatomy of ophthalmic aneurysm from the anatomical point of view. In this paper, we will start from the anatomical basis of ophthalmic aneurysm and analyze its intrinsic connection with ocular changes, with a view to improving the ophthalmologists’ level of diagnosis and management of such diseases. Objects and methods 1. Objects The 44 cases in this group were patients with ocular aneurysms admitted to the Department of Neurosurgery and Intervention of Beijing Tiantan Hospital affiliated with Capital Medical University in 2003-08/2009-03. Male 16 cases (36%), female 28 cases (64%). The age of the patients ranged from 32 to 47.3 years old on average. There were 2 cases of bilateral ophthalmic aneurysms, 2 cases of left-sided ophthalmic aneurysms, and 16 cases of right-sided ophthalmic aneurysms. Headache was the first symptom in 24 cases (55%), and ocular changes were the first in 14 cases (32%). Ophthalmologic examination: (1), visual function examination: visual acuity (logarithmic visual acuity meter to check the naked eye and corrected visual acuity), visual field (with arcuate visual field meter and automatic visual field meter); (2), eye protrusion: MARCO eye protruding meter for examination; (3), eye position and eye movement examination; (4), diplopia; (5), fundus examination: direct ophthalmoscopy, indirect ophthalmoscopy and fundus color Imaging Imaging tests: CTA; MRI/MRA; all patients underwent DSA) DSA examination. Surgery: All patients underwent aneurysm neck closure in our neurosurgery department or aneurysm embolization in our interventional department. Statistical analysis: all count data were expressed as cases and percentages. Results 1. Among the 44 patients with ocular manifestations, 32% had ocular changes as the first symptom. Among them, 12 cases of visual loss (27%) 14 eyes, monocular cases (23%), 2 cases of binocular (5%) of which, 5 cases of 7 eyes with visual acuity lower than the front of the eye manually, but there is no complete loss of vision; visual field defects in 10 cases (23% of the eyes, 8 cases of monocular, 2 cases of binocular; fundus hemorrhage in 10 cases (23%) 15 eyes; diplopia in 2 cases (5%) 2 eyes; ptosis in 4 cases (9%) 4 eyes; There were 2 cases (5%) of eyeball protrusion in 2 eyes; 2 cases (5%) of abducens nerve palsy in 2 eyes; 2 cases (5%) of misdiagnosed retrobulbar optic neuritis and 1 case (2%) of glaucoma. 2, extraocular manifestations of headache as the first symptom of 24 cases (55%), headache was sudden onset or intermittent severe pain or dull pain. Subarachnoid hemorrhage was found in 32 cases (73%), including 12 cases (27%) with a history of hypertension. Nausea and vomiting were present in 14 cases (32%). Limitation of limb movement was found in 4 cases (9%). There were 2 cases of unconsciousness (5%) and 2 cases of slurred speech (5%). There was 1 case of repeated massive nosebleed. 3.Imaging results of 44 cases of patients were diagnosed as ophthalmic aneurysm by DSA examination, with a positive rate of 100%. Among them, 20 cases at the same time for cranial CT examination, cases diagnosed as SAH, 2 cases diagnosed as saddle region occupancy; 24 cases of patients at the same time for cranial/MRA examination, 4 cases of negative results, 6 cases diagnosed as saddle region occupancy, 6 cases diagnosed as intracranial meningiomas, 2 cases of orbital cusp occupational lesions. This was shown to be the most effective examination for the diagnosis of ophthalmic aneurysms (Figure 1). Discussion 1. Anatomical basis of ophthalmic aneurysm The ophthalmic artery (OA) is the first major branch of the internal carotid artery after the cranium, and 83% of it originates from the subarachnoid space.The OA emanates from the dorsomedial side of the internal carotid artery under the anterior styloid process, and supplies the eyeball and intraorbital structures to the orbit via optic nerve canal, and its intracranial itinerary is located underneath the optic nerve. Ophthalmic aneurysms are aneurysms that arise from the portion of the internal carotid artery between the division of the ophthalmic artery and the division of the posterior communicating artery.4 o The incidence of intracranial aneurysms ranges from .47% to 9.26%. Ophthalmic aneurysms are closely related to the anterior styloid process, cavernous sinus, and ophthalmic artery ∞. The aneurysm of the ophthalmic artery is closely related to the anterior bedspace, cavernous sinus and ophthalmic artery ∞, large and giant type is more, the chance of rupture is also more, and is often accompanied by aneurysms in other parts of the artery (can be as high as 48.5%).3’7 o. Aneurysm in the clinic is easy to confuse with the tumor, the tumor body direct compression or tumor body hemorrhage, hematoma formation will be papilledema in 6 cases (14%) 12 eyes; optic nerve atrophy in 4 cases (9%) 6 eyes; cause focal symptoms. Therefore, it is especially important to understand the characteristics of ophthalmic aneurysm, early detection, early diagnosis and early treatment. The relationship between ophthalmic aneurysm and ophthalmology The headache caused by ophthalmic aneurysm occurs suddenly, and it is often a throbbing pain around the eye orbital area on one side, and the compression of the common carotid artery on the same side can make the pain relieved temporarily. In this article, headache as the first symptom of the case (55%), a sudden onset or intermittent severe pain or dull pain, may be due to the internal carotid artery around the sympathetic plexus dysfunction. Because of the intracranial stroke are located below the optic nerve, so the aneurysm can be directly or secondary rupture hemorrhage compression of the optic nerve, optic nerve, optic cross and optic bundle, causing ipsilateral or even contralateral visual disturbances, the optic cross is located in the basal cerebral plexus above the pterygoid pallidum, which is flanked by the internal carotid artery and posterior communicating arteries, and the OA is a section of the internal carotid artery between the distal loop of the internal carotid artery and the posterior communicating arteries, therefore, the ophthalmic aneurysm can cause corresponding Therefore, ocular aneurysm can cause corresponding visual field changes. In this study, there were 12 cases (27%) with decreased visual acuity and 10 cases (23%) with visual field defects. Ophthalmic aneurysms can compress the oculomotor nerve and cause paralysis. The oculomotor nerve travels to the base of the skull and has a long travel distance, so it can be compressed by aneurysms in many places and become paralyzed, and the diameter of a nonruptured aneurysm needs to be at least more than the diameter of the aneurysm to lead to the appearance of the symptoms related to eye movement ∞ o. Aneurysms causing oculomotor nerve paralysis combined with pupil involvement accounted for 97.5% of the cases 15 』 because the fibers that innervate the pupil are located in the dorsal internal superficial layer of the oculomotor nerve, and most of the posterior traffic The majority of posterior traffic aneurysms grow outward, backward, or downward, so the pupillary parasympathetic fibers are first damaged when the aneurysm compresses the arterio-ocular nerve, resulting in pupillary dilation and pupillary blunting of the reaction to light. The ophthalmic artery is the first and only branch of the internal carotid artery that originates from the medial side, and when the aneurysm is small or the hemorrhage is small, the compression of the arterio-ocular nerve is mild, resulting in an incomplete paralysis, which is often characterized by a ptosis of the eyelid. Although the parasympathetic nerve is also often affected, because there is often concomitant sympathetic nerve damage ∞ f o, the pupil may not appear to be dilated, or even narrowed. In this article, 4 cases of ptosis occurred, but no pupil dilation, which may be related to the simultaneous damage of sympathetic and parasympathetic nerves. Some of the cases in this group were referred from outside hospitals, with longer duration of disease, severe disease, once misdiagnosed as other intracranial lesions, eye disease, and more people with poor vision when they arrived at our hospital, especially those with poor monocular vision, loss of r binocular monocular function, although it showed 4 cases of damage to the movable H quite nerves, and 2 cases of damage to the abducens nerves, but it showed diplopia only in 2 cases.20%~40% of the ruptured aneurysms caused by SAH can be seen. Pre-, intra-, or subretinal hemorrhage, which may be accompanied by intravitreal hemorrhage (‘Ferson syndrome), may occur on one or both sides, or in patients with mild neurologic signs. 10% to 24% of large intracranial aneurysms may be associated with optic papillae edema, which is mainly related to a sudden and dramatic increase in intracranial j&, and may be associated with a sudden and dramatic increase in intracranial j&, which may be associated with a sudden and dramatic increase in intracranial j&. The cause is mainly related to the sudden and dramatic increase in intracranial J &, which may be accompanied by unilateral or bilateral abducens nerve palsy. 2 If the high cranial pressure is not relieved accurately and in time, the optic papilloedema may evolve into secondary optic nerve atrophy with irreversible loss of vision. Due to the rupture of ophthalmic aneurysm m blood can cause ophthalmic venous reflux obstruction, and the present pulsatile eyeball protrusion, ocular motility disorders, orbital pressure and intraocular pressure increase, in this paper there are two cases of misdiagnosis of posterior bulbous optic neuritis and cases of misdiagnosis of glaucoma. 3.Ophthalmic aneurysm diagnosis and imaging examination Intracranial aneurysm often has 3 aspects of performance: (1), most of the intracranial aneurysms are post rupture causing subarachnoid hemorrhage I and was found. (2), A few produce special syndromes by affecting neighboring nerves or brain tissues. (3) Some aneurysms are so large that they cause symptoms of increased cranial pressure. The possibility of aneurysm should be considered in the following cases: 1) Sudden onset of subarachnoid space in middle-aged or older people. 2) Paralysis of one side of the motor or abducens nerve. 3) Migraine headache. 3), Migraine-like attacks with paralysis of the extraocular muscles on one side. 4), Repeated massive nosebleeds with progressive reduction of vision on one side. For the majority of aneurysm patients, the diagnosis of aneurysm is mainly based on the corresponding clinical manifestations of subarachnoid hemorrhage caused by aneurysm compression on adjacent nerves and brain tissues or aneurysm rupture, as well as the diagnosis of cerebral currying and ductography. DSA is the most reliable and meaningful diagnostic method to confirm the diagnosis of aneurysm. Through cerebral angiography, together with digital subtraction method, magnification method and different angles of rapid consecutive film taking, it can not only show the existence of aneurysm, but also determine its location, morphology, size of aneurysm, width of aneurysm neck, direction of expansion, number of aneurysms and the relationship with neighboring arteries, degree of atherosclerosis, supplying blood vessels, good or bad collateral circulation, the presence or absence of cerebral vasospasm, intracranial hematoma, and the presence or absence of congenital cerebrovascular anomalies. Cerebrovascular anomalies. Craniocerebral radiographs can only show such secondary changes when the aneurysm is calcified or when the bone of the surrounding tissues is altered, and cannot directly show the presence of the aneurysm. Therefore, craniocerebral plain film has a low detection rate of aneurysms.CT scanning and MRI imaging are not as good as in determining the presence, size, or location of an aneurysm, but they are safe, rapid, painless for the patient, and do not affect the intracranial pressure, and they can be used at any time and can be observed at any time.CT scanning: it is difficult to detect aneurysms that are small, and can be detected for those that are large, with a wide variety of morphologies. It can find intracerebral hematoma formed by aneurysm rupture, intraventricular hemorrhage and subarachnoid hemorrhage, especially small amount of hemorrhage or formation of hematoma, which is often not shown by I)SA. MRI imaging examination: it can show small aneurysm and a small amount of nm. when neurological signs are not obvious, the patient often consults the ophthalmology department first, and the ophthalmologists should pay attention to it, so as to make a timely and correct diagnosis and treatment, so as to avoid the aneurysm suddenly rupture and endanger the life. This is a life-threatening case. In this paper, 20 patients first underwent cT examination, 18 cases were diagnosed as SAH, and 1 case was diagnosed as saddle tower: lesion. cT scanning is the best way to diagnose SAH, but in most cases, the aneurysm could not be directly detected, and it usually manifested itself as a substantial lesion in the saddle region.3j. The MRI manifestation of the aneurysm is complex and variable, and its signals are related to multi-fq,idleness elements. In this paper, 18 patients underwent cranial MRI, 4 cases had negative results, 6 cases were diagnosed as saddle region occupations, 6 cases were diagnosed as intracranial meningiomas, and cases were orbital cusp occupational lesions. This shows the limitations of cranial CT and MRI in diagnosing ophthalmic aneurysms, and this group of patients was finally diagnosed with H burgundy aneurysm by DSA.MRA (magnetic resonance angiography) has occupied a certain position in the diagnosis of intracranial aneurysms, however, it still can’t replace DSA, but because of the advantages of not injecting contrast agents and non-invasiveness, it can be used as a routine screening tool. Although it is the most reliable and meaningful diagnostic method to confirm the diagnosis of aneurysm, Zhu Xianli et al. Ij emphasized that it cannot completely rely on imaging, but should be combined with the comprehensive analysis of medical history, physical examination and other special examinations, and it can also be adopted to increase the special projection position, microcatheterization and repeat the imaging after …? Repeat imaging after a period of time to avoid missed aneurysms. To summarize, when the scarf elderly patients simply have motor nerve palsy as the first symptom, and there is no obvious improvement of the symptoms after internal conservative treatment, intracranial aneurysm should be highly suspected, and CTA, MRA and DSA should be performed in time to avoid leakage of the diagnosis if necessary. The headache with unknown cause is accompanied by vision loss and cranial nerve palsy. In particular, the possibility of ophthalmic aneurysm should be taken into account in the case of motor nerve disorders. When ophthalmologists first diagnose such patients, they should consult with neurologists to avoid misdiagnosis or missed diagnosis.