Relationship between the morphology of A-1 segment of anterior cerebral artery and anterior communicating artery aneurysms

Background

The anterior communicating artery (ACoA) is one of the most frequent sites for cerebral aneurysm. The peculiar directions of projection of aneurysms offer great challenges to clinical treatment.

Objetives

To establish the relationship between morphology of A-1 segment of anterior cerebral artery (ACA) and aneurismal projection.

Methods

Randomly selected digital subtraction angiography data of 264 anterior communicating artery aneurysms (ACoAA) cases and 296 cases of other cerebral vascular diseases in the same period were retrospectively analyzed.

Results

Among 264 ACoAA patients, the morphology of A-1 segment showed type 1a in 158 sides, type 1b in 11, type 2a in 35, type 1 2b in 87, type 3 in 171 and absence in 66. The morphology of A-1 segment in 296 patients with other cerebral vascular diseases displayed type 1a in 195 sides, type 1b in 20, type 2a in 47, type 2b in 74, type 3 in 217 and absence in 39. The non-visualization of A-1 segment in the group of ACoAA occurred more than in the control group (χ²=11.482, p=0.001). The classifications of ACoAAs in 264 patients were confirmed as anterior-superior type in 121 cases, anterior-inferior type in 105, complicated type in 16, posterior-inferior type in 12 and posterior-superior type in 10. The correlation between morphology of A-1 segment of ACA and classifications of ACoAA was significant (p=0.000; C=0.619, p=0.000). The direction of ACoAA was downward when the A-1 segment of ACA was Type 1a or Type 2a, and was upward when it was Type 1a or Type 2a and was upward or downward or complicated when it was Type 3.

Conclusion

The relationship between morphology of A-1 segment of ACA and classification of ACoAA is clarified in the present study, which is helpful to surgical treatment.     

纵裂入路处理大脑前动脉远段动脉瘤的外科策略-解剖研究

目的：通过对大脑前动脉远段的显微解剖,尤其是A3段下半胼周与胼缘动脉间关系,旨在提出处理大脑前动脉远段动脉瘤的外科策略。方法：在10具血管经彩色乳胶灌注的尸头上检查大脑前动脉远段区域的显微解剖,了解胼周动脉胼下段与胼缘动脉及胼周动脉A2段与额极动脉的关系,同时测量鼻根部与胼缘动脉起点处近端胼周动脉长轴延长线与额部交点（PC点）间的距离,并模拟外科入路至大脑前动脉远段动脉瘤。结果：胼周胼缘动脉结合部位于A3段的胼上段和胼下段分别占55％和45％,对于胼下型者,获得载瘤动脉的近端控制较为困难。在尸头标本和T2RMRI正中矢状位上,从鼻根部到PC点的平均距离分别是31.52 mm和34.64 mm。通过前纵裂入路接近PC点下方大脑前动脉远段的胼下动脉瘤并建立有效的控制仅有一有限的操作空间。结论：当在PC点上方入路时,在解剖和夹闭动脉瘤前要想建立有效的近端控制,切开胼胝体前端是必要的。PC点是计划胼下型大脑前动脉远段动脉瘤外科策略的重要外科标志。     

大脑前动脉的A1优势征及在前交通动脉瘤脑血管造影诊断中的意义

目的：探讨A1优势征的影像学表现及其出现率与大脑前交通动脉瘤的关系.方法：回顾性分析128例脑动脉瘤数字减影脑血管造影的影像学资料.以大脑前交通动脉瘤作为试验组,其他部位的动脉瘤作为对照组.结果：128例病人中,共139个动脉瘤.前交通动脉瘤49个,后交通动脉瘤41个,基底动脉瘤29个,大脑中动脉瘤14个,颈内动脉瘤6个.A1优势征58例,A1对称75例.结论：前交通动脉瘤Al优势征多见,其出现率与其他部位脑动脉瘤之间存在显著差异（P＜0.05）.     

经额底纵裂入路前交通动脉复合体的显微解剖研究

目的探讨显微解剖下经额底纵裂入路及相应的前交通动脉复合体相关指标,分析前交通动脉复合体结构分布情况。方法选择完整浸泡于10%福尔马林的成人尸头标本15具(30侧),在显微镜下经额底纵裂入路进行解剖,检测和分析大脑前动脉远侧部位和前交通动脉复合体的显微解剖相关指标,观察重要动脉血管分布情况。结果大脑前动脉A1段的左侧管径(2.67±0.29)mm,长度(133.68±1.63)mm;右侧管径(2.24±0.35)mm,长度(13.21±1.31)mm;出现变异的标本有2例(13.3%)。A2段的左侧管径(2.48±0.43)mm,长度(19.24±3.27)mm;右侧管径(2.51±0.52)mm,长度(20.15±3.54)mm;均未见变异和不对称情况。前交通动脉的长度为0~8.9 mm,平均(3.51±0.88)mm;直径为0~4.0 mm,平均(1.24±0.61)mm。前交通动脉的穿通支有1~5支,平均(2.3±1.01)支。Heubner回返动脉未见发育异常,其长度为21.14~37.52 mm,平均(27.11±3.15)mm。结论经额底纵裂入路对人体头颅进行解剖,分析前交通动脉复合体相关指标,明确了该部位的解剖结构及分布情况,有助于指导该部位前交通动脉复合体的结构分析、病变探索和临床手术。     

Dissecting aneurysm of the pulmonary artery

Summary Dissecting aneurysm of the aorta is often seen; similar changes in the pulmonary artery are rare. In the German literature they are unknown. 11 previously described cases have been compiled with their clinical and pathological records, and a new added. The patient, a 45 year old woman, suffered from pulmonary hypertension which resulted in medionecrosis and a large aneurysm of the trunk of the pulmonary artery. She died of haemopericardium after rupture of the artery in two stages, with a tear of 8 cm in the trunk which reached to the bifurcation of the vessel.     

手术夹闭合并同侧胚胎型大脑后动脉的后交通动脉瘤预后因素分析

目的探讨手术夹闭存在胚胎型大脑后动脉的后交通动脉瘤(PCoAA)预后的影响因素。方法选择徐州医科大学附属医院神经外科2015年1月至2019年1月经显微手术夹闭合并胚胎型大脑后动脉的PCoAA患者80例,术后6个月采用改良Rankin量表评价患者预后,采用单因素分析和多因素Logistic回归分析影响患者预后的因素。结果性别、动脉瘤侧别、宽颈、动脉瘤大小、脑梗死史、手术时机、高血压史对手术预后影响不大;而年龄、Hunt-Hess分级、改良Fisher分级是影响手术预后的危险因素。结论年龄、术前Hunt-Hess分级以及改良Fisher分级是患者预后不良的独立影响因素;对于年龄不大、Hunt-Hess低分级、改良Fisher低分级这类患者,更早进行显微外科手术治疗,安全性更高,预后更好。     

LEO+Baby单支架辅助弹簧圈栓塞前交通动脉瘤的有效性及安全性

目的评价专为小血管设计的低剖面、自膨式LEO+Baby单支架辅助弹簧圈栓塞前交通动脉瘤的有效性和安全性。方法回顾性分析应用LEO+Baby单支架辅助弹簧圈栓塞技术治疗的52例前交通动脉瘤患者的临床资料,统计患者基本信息、影像学资料、手术情况及并发症情况。结果52例前交通动脉瘤患者应用LEO+Baby支架51枚,1例患者支架导管到位困难,转开颅手术治疗,其余均操作成功,成功率为98%(51/52);术后即刻造影动脉瘤完全栓塞42例,瘤颈残留9例。术中动脉瘤破裂1例,支架内血栓形成3例,术中弹簧圈脱出1例。术后随访6~12个月,改良Rankin量表(mRS)评分为4~5分2例,2~3分5例,随访无死亡病例。46例患者术后6个月DSA复查结果显示完全栓塞率89.1%(41/46),其余5例未行DSA复查;无支架相关并发症及动脉瘤再破裂出血发生。头颅CT显示,无迟发性脑梗死、脑出血发生。结论应用LEO+Baby单支架辅助弹簧圈栓塞前交通动脉瘤操作成功率和安全性高、围术期并发症少且短期预后良好。     

应用MRA研究大脑前动脉A1段发育与交通动脉开放之间的关系

目的　探讨大脑前动脉A1段发育与前后交通动脉开放情况之间的关系。方法 回顾性分析了107例3.0T磁共振血管成像（MRA）无脑血管病的检查者和体检者。观察双侧大脑前动脉A1段发育、前交通动脉和双侧后交通动脉开放情况,测量双侧大脑前动脉A1段、前交通动脉及后交通动脉的管径,分析二者的相关性。  结果　①右侧大脑前动脉A1段发育不良占22.43%（24/107）,缺如占0.93%（1/107）,左侧大脑前动脉A1段发育不良占16.82%（18/107）,缺如占1.87%（2/107）。②前交通动脉开放占47.66%（51/107）。③单侧或双侧后交通动脉开放共有39例,其中双侧同时开放占21例,仅左侧开放占7例,仅右侧开放占11例。④大脑前动脉A1段发育不良与交通动脉开放相关（r=0.654,P＜0.01）。  结论 大脑前动脉A1段发育不良可引起交通动脉代偿性开放。     

11例夹层动脉瘤术后护理体会

目的总结夹层动脉瘤患者人造血管置换术后的护理体会。方法人造血管置换术后积极护理配合,密切观察患者的生命体征,做好健康教育。结果 11例患者人造血管均成功植入,无1例出现并发症,患者均在术后2周内康复出院。结论正确的护理有利于患者夹层动脉瘤术后的康复。     

大脑前动脉和中动脉水平段的立体定位及其临床意义

在100套正常成人脑血管造影正、侧位 X 线片上,测量了颈内动脉分杈点和大脑前、中动脉由水平位转向上的转角点在立体坐标中的位置。该坐标的原点位于外耳门前上缘,向前至眶下缘最低点的连线为 x 轴;向上的垂线为 y 轴:伸向内侧垂线为 z 轴。在 xoy 平面上可确定大脑前、中动脉在颅侧面投影位置,在 z 轴上的数值可确定它们在颅侧面的深度。     

经右股动脉行肾动脉下腹主动脉腔内球囊阻断血流的应用解剖学研究

目的探讨经右股动脉入路应用球囊导管阻断肾动脉下腹主动脉的可行性。方法解剖50例健康成人尸体标本（其中男性33例,女性17例）,测量身高;分别经血管腔内测量肾动脉下腹主动脉至右股动脉腹股沟韧带平面的长度,采用sPSs12．0统计学软件分析身高与血管长度之间的关系。结果身高与肾动脉下腹主动脉至右股动脉腹股沟韧带平面的长度之间存在直线回归及较强的相关关系。结论经右股动脉入路行血管腔内球囊阻断肾动脉下腹主动脉对于腹主动脉瘤,特别是破裂腹主动脉瘤是一个可行的安全阻断血流的方法,为临床工作提供了一个新的思路和方法。     

Coronary artery aneurysms and coronary artery fistula as a cause of angina pectoris

Coronary artery aneurysm is an uncommon disease. Coronary artery fistulae are infrequent congenital anomalies. A extremely rare case report of combination of coronary artery aneurysms and coronary artery fistula is presented with a brief literature review.     

Morphological findings in idiopathic calcification of the ascending aorta and aortic valve affecting a young woman

The pathology of a case of idiopathic calcification affecting the ascending aorta in a young woman is presented. A varying width of media throughout the aorta and extending into its proximaques of calcium, found in the acellular media, were confined to the ascending aorta. No inflammatory or reparative reaction was seen in the vessel wall. Electron microscopically, the calcium seemed to have an affinity for elastic tissue elements of all sizes and the mode of deposition appeared to be by 'avenues' of the microfibrillar component. Possible pathogenetic mechanisms are discussed.     

大脑中动脉分叉处动脉瘤夹闭术中显露大脑中动脉M1段的手术策略

目的 探讨大脑中动脉分叉处(MCBIF)动脉瘤开颅夹闭术中安全显露大脑中动脉M1段的手术策略。方法 回顾性分析2012年3月—2018年3月山西大医院神经外科手术治疗的60例(65个)MCBIF动脉瘤患者的临床资料,其中男29例、女31例,发病年龄35～65(40±0.5)岁。动脉瘤出血Hunt-Hess分级0级3例,Ⅰ级13例,Ⅱ级13例,Ⅲ级16例,Ⅳ级7例,Ⅴ级8例。在冠状位最大密度投影(MIP)图像上观察到,动脉瘤指向上方27个、指向外侧22个、指向下方16个。测量动脉瘤同侧大脑中动脉M1段的长度,观察M1段的曲度,模拟翼点开颅手术入路;采取近端或远端入路手术,指向下方和外侧的动脉瘤从上方显露大脑中动脉M1段,指向上方的动脉瘤从下方显露大脑中动脉M1段,并选择合适的动脉瘤夹夹闭动脉瘤。随访并观察动脉瘤复发情况,预后评价采用格拉斯哥预后评分(GOS),并比较不同指向动脉瘤的预后差异。结果 大脑中动脉M1段长度为8.2～16.5( 13.5±0.3)mm。M1段曲度向下,动脉瘤指向上;M1段曲度向上,动脉瘤指向下;M1段平直向外,动脉瘤指向外。 CTA三维影像模拟手术入路中动脉瘤以及与周围血管的解剖关系与手术中所见解剖结构完全相符。所有动脉瘤夹闭可靠,术后6个月复查头颅CTA未见动脉瘤复发。随访6～36(18.0±2.5)个月,末次随访结果GOS评分:5分37例,4分10例,3分4例,2分3例,1分6例,不同指向动脉瘤的预后良好率比较差异无统计学意义(P＞0.05)。结论 充分利用CTA三维重建技术,明确动脉瘤的指向、大脑中动脉M1段的长度和曲度,精确评估大脑中动脉分叉处动脉瘤和M1段在侧裂内的投影方位,避开动脉瘤顶,采取合适的策略显露M1段,有效做到近端控制,是手术安全进行的可靠保障。     

锁孔择期手术治疗破裂的大脑中动脉瘤32例

目的探讨锁孔神经外科手术治疗后交通动脉瘤的手术技巧和适应证。方法回顾性分析32例破裂的大脑中动脉瘤病例,全部经DSA或CTA确诊,出血2周后行眉弓上锁孔开颅,显微神经外科手术动脉瘤夹闭。结果 32例全部夹闭,无1例死亡,治愈率100%。术后1周内头部CTA,动脉瘤消失,载瘤动脉通畅,动脉瘤夹固定良好。10例于术后3～6个月进行了随访（CTA或DSA）,未见复发。结论锁孔手术是治疗大脑中动脉瘤的微创治疗技术,减少了手术创伤及并发症,恰当地选择适应证和手术时机及应用显微外科技术是治疗的关键。     

改良眶翼点入路开颅治疗前交通动脉瘤破裂的疗效优势

目的分析改良眶翼点入路进行开颅手术治疗前交通动脉瘤破裂的疗效。方法回顾性分析湖北医药学院附属襄阳市第一人民医院收治的134例前交通动脉瘤破裂患者的临床资料,根据手术路径的不同分为对照组(左侧翼点入路进行开颅手术)和观察组(改良眶翼点入路进行开颅手术),每组67例。比较2组患者出院后6个月的神经恢复情况,比较2组患者手术前后(术前、术后1 d、出院后1个月、出院后6个月)髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100β)含量及Barthel指数差异,比较2组患者术后6个月内不良事件发生情况。结果观察组患者出院后6个月神经恢复情况显著优于对照组,中残和重残患者人数显著少于对照组,2组比较差异具有统计学意义(P<0.05)。随着时间迁移,2组患者MBP、NSE、S100β指标含量及Barthel指数均显著上升,组内不同时点比较差异有统计学意义(P<0.05);出院后1、6个月,观察组患者MBP、NSE、S100β指标含量显著低于对照组,Barthel指数显著高于对照组,差异具有统计学意义(P<0.05)。观察组患者术后6个月病死率显著低于对照组,2组比较差异具有统计学意义(P<0.05)。结论采用改良眶翼点入路开颅治疗前交通动脉瘤破裂的临床效果优异,可广泛应用于临床。     

Three‐dimensional morphometry of the A2 segment of the anterior cerebral artery with neurosurgical relevance

Most prior morphometry data regarding the A2 segment of the anterior cerebral artery (ACA) have been based on cadaveric measurements. With newer imaging modalities, surgical techniques, and minimally invasive procedures, new standards for the anatomy of this vessel are necessary. A novel computer‐based data system was used to analyze the three‐dimensional (3D) morphometry of 230 A2 segments. In addition, tortuosity (TI) and deviation indices (DI) for this segment were calculated. The mean internal diameter of the A2 segment was 1.86 mm, and segments tended to be larger in men and on left sides. A2 segments were asymmetrical in 43%, and this was more common in women. Lengths tended to be greater on right sides and in men. Volumes were greater in men and increased with age, which was statistically significant. These gender differences were found to be statistically significant (P < 0.05), for both volume and diameter. TI was equal among sides, but DI was more often greater on right sides. The correlation coefficient ratio for length and DI was statistically significant. It is important to understand various 3D morphometrical differences particularly between genders. By constructing blood flow simulation models and during revascularization procedures, surgeons are able to gain a better understanding of each patient's vascular anatomy. These additional 3D data regarding the anatomy of the postcommunicating parts of the ACA may be useful to the neurosurgeon and interventional neuroradiologist. These data may assist with an earlier diagnosis of pathologies affecting the 3D morphology of the ACA. Clin. Anat. 23:759–769, 2010. © 2010 Wiley‐Liss, Inc.     

Association between internal carotid artery morphometry and posterior communicating artery aneurysm

PURPOSE: The goal of this study was to directly measure the association between the internal carotid artery (ICA) morphometry and the presence of ICA-posterior communicating artery (PCOM) aneurysm. MATERIALS AND METHODS: The authors intraoperatively measured the length of the supraclinoid ICA because it is impossible to radiologically determine the exact location of the anterior clinoid process. We used an image analyzer with a CT angiogram to measure the angle between the skull midline and the terminal segment of the ICA (ICA angle), as well as the diameter of the ICA. The lengths and diameters of the supraclinoid ICA and the ICA angle were compared among PCOM aneurysms, anterior communicating artery (ACOM) aneurysms, and middle cerebral artery (MCA) bifurcation aneurysms (n=27 each). Additionally, the lengths and the diameters of M1 and A1 were compared for each aneurysm. RESULTS: The lengths of the supraclinoid ICA were 11.9+/-2.3 mm. The lengths of the supraclinoid ICA in patients with ICA-PCOM aneurysms (9.7+/-2.8 mm) were shorter than those of patients with ACOM aneurysms (13.8+/-2.2 mm, Student's t-test, p<0.001) and with MCA bifurcation aneurysms (12.2+/-1.9 mm, Student's t-test, p<0.001). The diameters of the supraclinoid ICA and A1 in patients with ACOM aneurysms were larger than those in patients with MCA bifurcation aneurysms (Student's t-test, p<0.05). There were no significant differences in the lengths of M1 and A1, ICA angle, or diameter of M1 for each aneurysm. CONCLUSION: These results suggest that the relatively shorter length of the supraclinoid ICA may be a novel risk factor for the development of ICA-PCOM aneurysm with higher hemodynamic stress.     

主动脉夹层动脉瘤合并肺动脉夹层动脉瘤猝死病例报道及文献回顾

目的：对罕见的主动脉及肺动脉同时发生的夹层动脉瘤进行报道并讨论其死亡原因。方法：分析1例因主动脉夹层动脉瘤合并肺动脉夹层动脉瘤猝死病例的解剖所见、组织学特征,结合文献分析讨论。结果：死者男性,76岁,因外力打击后猝死于家中。解剖所见主动脉、肺动脉夹层动脉瘤形成,肺动脉各级分支夹层动脉瘤形成伴动脉管腔狭窄。组织学证实大动脉动脉粥样硬化。结论：主动脉合并肺动脉夹层动脉瘤非常罕见,病情凶险,易引起猝死。