易形成前交通动脉瘤的血管模式再探讨

目的探讨易形成前交通动脉瘤的血管模式。资料与方法将1081份正常磁共振血管成像(MRA)图像定义为一般国人脑血管形态类型,与49例前交通动脉瘤患者脑血管形态类型进行对照。结果49例前交通动脉瘤中一侧A1优势型45例(占87.76%),与正常国人一侧A1优势型和其他类型构成差异有统计学意义(P<0.0001)。其中左侧A1优势型(33例)约为右侧A1优势型(12例)的3倍,与一般人群左侧A1优势型与右侧A1优势型比(11.19%/3.98%)差异无统计学意义(P=0.952)。一侧A1优势型前交通动脉双侧大脑前动脉A2段起始部夹角测量有瘤患者夹角平均值为174.5°,无瘤患者平均值为113.45°,两夹角差异有统计学意义(t=14.198,P=0.002)。结论一侧A1优势供血与前交通动脉瘤的形成相关,造成前交通动脉瘤左右侧差异的原因是一侧A1优势型发育左右侧存在差异,双侧大脑前动脉A2段夹角增大更易形成动脉瘤。对发现的此种血管模式应随访。     

显微外科手术治疗前交通动脉瘤疗效分析

目的探讨前交通动脉瘤显微外科手术治疗方法和疗效。方法采用翼点人路治疗前交通动脉瘤24例,所有患者均实行直接夹闭术。结果出院时治疗结果良好17例,致残5例,死亡2例,术后随访6个月～2年,未出现动脉瘤再次出血。结论熟练掌握翼点入路治疗前交通动脉瘤的显微手术方法,术中可获得良好的暴露,术后可减少并发症的发生．使患者获得一个良好的转归。     

Spontaneous thrombosis of a giant intracavernous internal carotid artery aneurysm and ipsilateral internal carotid artery occlusion

A 75-year-old man who had suffered from right visual disturbance for 10 years suddenly experienced right cavernous sinus syndrome. Magnetic resonance imaging revealed a giant thrombosed aneurysm in the right cavernous sinus extending to the right middle cranial fossa. Digital subtraction angiography disclosed occlusion of the right internal carotid artery at the petrous portion and good cross filling in the right-sided circulation through the anterior communicating artery. There was no filling of the aneurysm. In this case, the mechanism of parent artery occlusion is unclear, but direct compression and stretching of the parent artery by the aneurysm may be involved.     

Post-traumatic aneurysmal rupture involving the circle of Willis affected by fibromuscular dysplasia. A case report and systematic review

The fatal rupture of a saccular aneurysm at the junction between the left anterior cerebral artery and anterior communicating artery affected by fibromuscular dysplasia (FMD) is a rare condition. Here is reported the case of a subject involved in a road traffic accident a few minutes before the death, which opened the debate on the real cause of death in a forensic setting.By autopsy, the examination of the brain revealed subarachnoid haemorrhage with flooding of the ventricles due to the breached saccular aneurysm of the junction between the left anterior cerebral artery and anterior communicating artery, in FMD mainly affecting the circle of Willis arteries. A spontaneous aneurysmal rupture was excluded on the basis of probabilistic analysis, in the presence of alternative hypotheses that could explain the facts. The passenger’s delayed loss of consciousness may be explained as much by a hypertension-linked rupture of the aneurysm triggered by the emotional stress experienced, as by the traumatic shaking/impact of the aneurysm against the bony skull structures, in a subject predisposed to aneurysm frailty due to FMD.Overall, the concausal role of both the road traffic accident, typified by high kinetic energy, and the presence of a pre-existing aneurysmatic weakness due to FMD is fully recognized.The identification of anatomical variants, jointly with uncommon diseases at the examination of the brain base arteries in any case of isolated basal subarachnoid haemorrhage, may avoid wrong legal consequences even when the cause of death seems to be obviously of simple traumatic origin.     

Giant aneurysm of anterior communicating artery simulating 3rd ventricular tumor.

This is a case report of an anterior communicating artery aneurysm simulating a 3rd ventricular tumor with obstructive hydrocephalus demonstrated on CT scan. Angiography showed the "tumor" to be an aneurysm. We believe that giant aneurysms of the anterior communicating artery should be included in the differential diagnosis of suspected 3rd ventricular tumors along with suprasellar masses as seen on CT scans.     

Infraoptic anterior cerebral artery or carotid–anterior cerebral artery anastomosis: A very rare embryological variation. Case series and review of literature

PurposeAn infraoptic course of the anterior cerebral artery (ACA) is a rare cerebrovascular variation that can be associated with anterior communicating artery aneurysm. The purpose of this study is: 1. Describe infraoptic ACA or Carotid-ACA anastomosis. 2. Discuss the embryology. 3. Demonstrate this rare variation on CT/MR angiography. 4. Discuss its clinical significance. 5. Understand the anatomy for appropriate management of associated vascular pathology (Anterior communicating aneurysm). 6. Literature review.MethodsWe describe 2 cases with CT/MR angiographic findings of this rare vascular variation along with review of embryology and literature.Results and conclusionGenerally, ACA arises from the internal carotid artery (ICA) terminus and runs medially superior to the optic nerves and communicates with contralateral ACA through the anterior communicating artery. An infraoptic course of the A1 segment of the ACA is associated with a low ICA bifurcation, usually located intradurally at or just above the level of the origin of the ophthalmic artery. Rarely, infraoptic origins of A1 are proximal or at the level of origin of the ophthalmic arteries and arise below the optic strut possibly extradurally. Abberant ACA course has been shown to be associated with aneurysms which needs prompt recognition, to allow optimum treatment planning (surgical/endovascular). Our first case has bilateral infraoptic ACA seen on CT angiography. The second case has ipsilateral (right) infraoptic ACA with associated anterior communicating artery aneurysm.     

Horizontal Neuroform stent deployment for a ruptured basilar terminus aneurysm via the posterior communicating artery

The authors describe the endovascular management of a ruptured wide-necked basilar terminus aneurysm with stent-assisted coil technique via posterior communicating collateral vessels from the anterior cerebral circulation. A Neuroform stent was placed horizontally across the neck of the aneurysm with use of the patient's large, patent, posterior communicating artery. This approach allowed for complete endovascular treatment in the setting of acute subarachnoid hemorrhage.     

A rare anatomic variant of a solitary internal carotid artery associated with moyamoya phenomenon of the middle cerebral artery

A case of a congenital solitary internal carotid artery with complicated anastomosis is presented. This rare anomaly was an incidental finding at cerebral angiography in a patient with a poor-grade subarachnoid hemorrhage and a ruptured anterior communicating artery aneurysm.     

Neck-bridge device for combined endovascular and surgical treatment of a giant anterior communicating artery aneurysm

We report the case of a 58-year-old man with a giant partially thrombosed anterior communicating artery aneurysm, which presented with mass effect. Our treatment strategy consisted of endovascular aneurysm circulatory exclusion prior to surgical resection. To do so, we first occluded both the two A1 segments and the aneurysm neck with a neck-bridge device to prevent further coil migration within the aneurysm sac. Five days later, the aneurysm was surgically removed.     

Effects of Circle of Willis Anatomic Variations on Angiographic and Clinical Outcomes of Coiled Anterior Communicating Artery Aneurysms

BACKGROUND AND PURPOSE:Anterior communicating artery aneurysms account for one-fourth of all intracranial aneurysms and frequently occur in the context of A1 vessel asymmetry. The purpose of this study was to correlate circle of Willis anatomic variation association to angiographic and clinical outcomes of anterior communicating aneurysm coiling.MATERIALS AND METHODS:The Cerecyte Coil Trial provides a subgroup of 124 cases with anterior communicating artery aneurysms after endovascular coiling. One hundred seventeen of 124 anterior communicating artery aneurysms had complete imaging and follow-up for clinical outcome analysis, stability of aneurysm coil packing, and follow-up imaging between 5 and 7 months after treatment. Clinical outcomes were assessed by the mRS at 6 months.RESULTS:Anterior cerebral artery trunk-dominance was seen in 91 of 124 (73%) anterior communicating artery aneurysms and codominance in 33 of 124 (27%) anterior communicating artery aneurysms. There was no significant difference (P > .5) in treatment success at 5–7 months for anterior communicating artery aneurysms between the anterior cerebral artery trunk-dominant (49 of 86, 57%) and anterior cerebral artery trunk-codominant (19 of 31) groups. Angiographic follow-up demonstrates a statistically significant increase in neck remnants and progressive aneurysm sac filling with the A1 dominant configuration (n = 21, 24% at follow-up versus n = 11, 12% at immediate posttreatment, P = .035). There was no statistically significant difference in clinical outcomes between types of anterior cerebral artery trunk configuration (P > .5).CONCLUSIONS:Anterior communicating artery aneurysms with anterior cerebral artery trunk-dominant circle of Willis configurations show less angiographic stability at follow-up than those with anterior cerebral artery trunk-codominance similar to other “termination” type aneurysms. This supports the hypothesis that anterior cerebral artery trunk-dominant flow contributes to aneurysm formation, growth, and instability after coiling treatment.

The most common site of intracranial aneurysms is the anterior communicating artery (AcomA). AcomA aneurysms account for approximately one-fourth of all intracranial aneurysms.¹ Also very common in the setting of AcomA aneurysms is unilateral anterior cerebral artery trunk (A1) dominance where 1 side supplies both pericallosal artery (A2) arteries, a well-known phenomenon previously shown to be a potent risk factor for AcomA aneurysm formation and rupture.^1–3To what extent vessel dominance influences the long-term result of endovascular packing of these aneurysms with detachable platinum coils and the patients'' clinical outcome is less well known.^4–6 One previous study indicates that vessel dominance is not a major factor in predicting short-term treatment outcome; however, the methodology and definition of vessel dominance as used in this instance was not stated.⁷ Yet, anterior communicating aneurysms are commonly “termination type” with the aneurysm forming with a relatively wide neck at the site of the inferred jet of flowing blood dynamics, with main branches nearly perpendicular to the parent vessel, also commonly seen for basilar tip, internal carotid tip, and middle cerebral bifurcations.⁸The Cerecyte Coil Trial (CCT) was a prospective, randomized, controlled study that entered 500 cases comparing endovascular coiling of ruptured and unruptured cerebral aneurysms with either Cerecyte or bare platinum coils that showed no difference between groups.^9,10 There was an expected large subset of AcomA aneurysms within the CCT cohort (n = 124).⁹ Therefore, data from this trial provided a unique opportunity to obtain a large number of AcomA aneurysm cases for determination of A1 dominance in relation to coiling treatment and angiographic outcomes immediately posttreatment and at follow-up. Our goal was to determine the impact of A1 dominance on treatment success, stability, and clinical outcomes of endovascularly coiled AcomA aneurysms.     

False-negative angiograms in subarachnoid haemorrhage due to intracranial aneurysms

Of 440 patients with spontaneous subarachnoid haemorrhage in whom an aneurysm was suspected, 60 had a negative angiogram. A second angiogram performed 1–4 weeks later revealed an aneurysm in 5 of 40 cases. Of these patients, 3 had a second haemorrhage. In all cases, diffuse bleeding, with involvement of the anteroinferior interhemispheric fissure, was present on CT. There were three aneurysms of the anterior communicating artery and two of the carotid siphon. The reasons for the false-negative angiograms and the usefulness of repeated angiography are discussed. Received: 19 December 1996 Accepted: 25 March 1997     

Pre-optic origin of the anterior cerebral artery

Summary Division of the internal carotid artery immediately after the siphon at the level of the ophthalmic artery is described in a 55-year-old woman. Because of the early division, the anterior cerebral artery lay between the optic nerves. This anomaly was combined with agenesis of the horizontal part of the opposite anterior cerebral artery. The problems concerning ligation of a ruptured anterior communicating artery aneurysm are discussed.     

Flow changes after endovascular treatment of a wide-neck anterior communicating artery aneurysm by using X-configured kissing stents (cross-kissing stents) technique

Endovascular treatment for a wide-neck anterior communicating artery (AcomA) aneurysm remains technically challenging. Stent-assisted embolization has been proposed as an alternative of treatment of complex aneurysms. The X-configuration double-stent-assisted technique was used to achieve successful coiling of wide-neck AcomA aneurysm. Implanted stent can alter intra-arterial flow. Follow-up angiograms 4 months later showed flow changes due to used X-technique of stents implantation and filling of the anterior cerebral artery from the opposite internal carotid artery.     

64层螺旋CT头颈动脉联合成像诊断颅内动脉瘤的应用价值

 目的 评价64层螺旋CT诊断颅内动脉瘤的临床应用价值。方法 选取我院176例颅内动脉瘤患者的头颈CTA(computed tomographic angiography,CTA)检查资料,评价颅内动脉瘤的大小、形态、位置及术后情况。结果 176例均行数字减影血管造影(digital subtraction angiography,DSA)存在动脉瘤(157经手术治疗),共计 201个动脉瘤,其中19例为多发动脉瘤。首次CTA明确诊断动脉瘤171例(196个),漏诊5例,阳性诊断率97.5%(196/201)。171例(196个)中颈内动脉瘤112例,后交通动脉瘤10例,前交通动脉瘤26例,基底动脉瘤5例,大脑中动脉瘤13例,大脑前动脉瘤5例,对照DSA再次重组首次漏诊的5例CTA图像,又发现动脉瘤2例,阳性诊断率提高至98.5%。结论 应用多层螺旋CT头颈血管联合成像选择合理的后处理方法,有助于提高图像质量与诊断的准确性,对临床术前评估与术后评价有重要意义。     

Delayed thromboembolic events 9 weeks after endovascular treatment of an anterior communicating artery aneurysm: case report

We present a case of delayed thromboembolic events that occurred 9 weeks after endovascular treatment of an anterior communicating artery aneurysm with GDC.     

DSA全脑血管造影431例分析

目的:分析431例全脑血管造影,探讨颅内血管病变用DSA全脑血管造影的价值。材料和方法:92年至96年行DSA全脑血管造影431例。采用Seldinger技术,经股动脉穿刺置管行选择性或/和超选择性全脑血管造影。前交通及后交通动脉瘤经显微神经外科证实。结果:动脉瘤155例,血管畸形76例,占位性病变48例。颅内动脉瘤发生在大脑前动脉系统为42.58％,而前交通动脉瘤为大脑前动脉系统的74.24％。颅内动脉瘤为全脑血管造影阳性发现的首位,其次为血管畸形,颅内占位。本组阴性率为25.75％。结论:CT、MR发现颅内出血或血管畸形时,不一定全脑血管造影有阳性改变。     

Aneurysm formation after carotid occlusion.

We present two cases of subarachnoid hemorrhage caused by aneurysm development and enlargement in the anterior communicating artery complex. The cases occurred in a series of 58 balloon occlusions for unclippable giant aneurysms of the internal carotid artery.     

Enterprise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤的临床研究

目的初步探讨和总结应用EnterPrise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤的技术及疗效。方法收治8例前交通宽颈动脉瘤(体/颈比<1.5)患者,均采用Enterprise支架辅助水解脱弹簧圈栓塞,其中6例先放置支架覆盖动脉瘤颈再将微导管经支架网孔放入动脉瘤腔填塞弹簧圈进行栓塞,2例在微导管进入瘤腔后再释放支架进行弹簧圈栓塞。术后6～12个月进行临床和DSA随访。结果 8例全部技术成功,支架到位满意,载瘤动脉通畅,无手术并发症;其中动脉瘤完全闭塞7例,闭塞95%以上1例,患者术后均恢复良好,临床随访6～12个月无再出血及脑血栓形成,其中DSA随访6例无支架狭窄及动脉瘤再通。结论 Enterprise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤是一种安全、可靠、有效的治疗方法,但其长期疗效仍需进一步观察。     

A retained neurointerventional microcatheter fragment in the anterior communicating artery aneurysm in multi-slice computed tomography angiography

We present a case of multi-slice computed tomography angiography of a 60-year-old patient with a retained fragment of microcatheter within an anterior communicating artery (AcomA) aneurysm. This is a rare complication of Guglielmi detachable coil embolization. After an unsuccessful embolization procedure, the patient underwent surgery. During clipping of an AcomA aneurysm, the microcatheter traveled up the pericallosal branch of the right anterior cerebral artery. Subsequently, the microcatheter fragment did not prevent normal blood flow through the artery, and the patient has been doing well without neurological sequelae.     

Intracranial aneurysm associated with pituitary adenoma shown by MR angiography: case report

We present a case of aneurysm of the anterior communicating artery associated with a pituitary adenoma. Recognition of this association has important clinical implications, leading to modification of the surgical approach. The aneurysm was shown on MR angiography and confirmed with contrast arteriography and at surgery.