前交通动脉复合体发生变异对前交通动脉瘤治疗的指导

目的 探讨前交通动脉(ACoA)复合体发生变异对ACoA动脉瘤治疗的指导意义.方法 观察60具胚胎复合体形态变异;回顾夹闭29例,栓塞49例ACoA动脉瘤的临床资料.结果 (1)大脑前动脉Al段(Al)成窗2例,发育不良15例,ACoA成窗12例,双支5例,胼胝体中央动脉4例,"Y"型4例,三支或以上1例,"H"型1例.复合体变异与性别差异无统计学意义,与胎龄无明显变化趋势.ACoA与Al变异无明显相关.(2)Al发育不良或缺如变异59例,ACoA双支2例,H型1例,瘤颈位于优势Al分叉部顶端55例,ACoA中间部19例,ACoA-A2段4例;术后无手术相关性死亡病例.结论 Al,ACoA形态在胎儿早期普遍存在变异;Al发育不良在动脉瘤多见,ACoA形态并非多样,优势Al的处理有助于ACoA动脉瘤的成功治疗.

The developmental variations of the anterior communicating artery complex and its clinical significance of the aneurysms

Objective To study the variation and development of anterior communicating artery(ACoA) complex and their effects on the treatment of aneurysms. Method Sixty fresh fetal cadavers and their variations of ACoA complex were observed. Twenty-nine patients with ACoA aneurysms received clipping surgery and 49 patients received embolization treatment successfully. Results 1. There was Al fenestration in 2 cases and dysplasia type in 15 cases. All variations of ACoA consisted of fenestration in 12 cases, duplication in 5, Y-shaped in 4, median artery of the corpus callosum in 4, plexiform in one, H-shaped in one. There was no significant difference between complex variations and the gender and age of patients. There was no significant correlation between variations of Al and ACoA. 2. Al dysplasia or absence of 59 patients with aneurysm and ACoA variations of 3 patients were also observed. The necks of aneurysms were located on the apex of bifurcation of dominant Al. The middle segment of ACoA of 19 patients and the ACoA-A2 of 4 patients were also found. There was no death related to operative techniques. Conclusions The variations of ACoA complex consequently exist early in fetal development. However, the variations of Al dysplasia and single form of ACoA are observed in the patients with aneurysms. The operative techniques of dominant Al are used to improve the safety of the treatment.