上突型宽颈前交通动脉瘤的分型和手术夹闭策略

目的探讨上突型宽颈前交通动脉瘤的分型和手术夹闭策略。方法回顾性分析经手术治疗的前交通动脉瘤患者的影像学及手术资料。根据术中显微解剖时双侧A2构成的虚拟平面与瘤体位置,划分上突型前交通动脉瘤的分型。结果上突型前交通动脉瘤分为4型:Ⅰ型,动脉瘤体位于双侧A2前方,使用直夹夹闭;Ⅱ型,动脉瘤体位于双侧A2之间,使用直开窗夹夹闭;Ⅲ型,动脉瘤体位于双侧A2后方,使用直开窗夹夹闭;Ⅳ型又分为Ⅳa型(A2平面开放型)和Ⅳb型(A2平面闭合型)。Ⅳa型同侧A2位于瘤体后方,对侧A2位于瘤体前方,使用直夹夹闭;Ⅳb型同侧A2位于瘤体前方,对侧A2位于瘤体后方,使用直开窗夹夹闭。结论本分型系统和夹闭策略有助于制定详尽的手术计划,减少手术并发症率和瘤颈残留率。使用直开窗夹和串联夹闭技术仍是上突型前交通动脉瘤夹闭治疗的重要手段。     

前交通动脉动脉瘤分型与手术入路选择

目的探讨前交通动脉瘤的分型及其在两种手术入路选择中的价值。方法根据术前DSA和/或CTA,以前交通动脉及双侧大脑前动脉A2段为参考平面,将前交通动脉动脉瘤分为Ⅰ~Ⅴ型：Ⅰ型,瘤体朝前;Ⅱ型,瘤体朝下;Ⅲ型,瘤体朝后;Ⅳ型,瘤体朝上;Ⅴ型,瘤体多朝向。从2012年1月至2014年5月采用显微手术夹闭前交通动脉动脉瘤52例,采取翼点入路28例,其中Ⅰ型动脉瘤8例,Ⅱ型9例,Ⅲ型3例,Ⅳ型7例、Ⅴ型1例;前纵裂入路24例,其中Ⅰ型5例,Ⅱ型7例,Ⅲ型2例,Ⅳ型10例。结果本组52例均一次性夹闭瘤体,1例夹闭后包裹,其余均夹闭满意。出院时GOS评分4~5分37例,2~3分13例,1分2例。结论Ⅰ型、Ⅱ型两种入路均适合选择,可依个人习惯选择;Ⅲ、Ⅳ、Ⅴ型选择纵裂入路更合适。     

支架辅助弹簧圈栓塞治疗大脑前动脉A1段起始处破裂微小动脉瘤

目的 探讨支架辅助弹簧圈栓塞治疗大脑前动脉A1段起始处破裂微小动脉瘤的安全性和有效性.方法 回顾性分析2010～2018年支架辅助弹簧圈栓塞治疗的11例大脑前动脉A1段起始处破裂微小动脉瘤的临床资料.结果 11例中,6例微导管塑形成“S”形,4例“Z”形,1例“猪尾形”.术后即刻造影显示,Raymond分级Ⅰ级9例,Ⅱ...     

前交通动脉瘤的显微外科治疗

1对象与方法1.1临床资料我院2002年1月～2003年10月施行前交通动脉瘤夹闭术69例,其中男45例,女24例;年龄32～65岁,平均46.7岁。本组均以蛛网膜下腔出血(SAH)起病,SAH2次15例,3次4例。有高血压病史者10例。术前按Hunt-Hess分级:Ⅰ级9例,Ⅱ级21例,Ⅲ级30例,Ⅳ级7例,Ⅴ级2例。表现为一侧肢体乏力或运动障碍6例,精神症状10例。1.2影像学检查均经DSA全脑血管造影确诊为前交通动脉瘤。动脉瘤仅能通过一侧颈内动脉造影显示者15例,52例存在一侧A1段明显发育不良,其中左侧17例,右侧35例。1例右侧A1缺如。根据DSA影像和手术所见,动脉瘤瘤体指向…     

支架辅助栓塞破裂性前交通宽颈动脉瘤

目的 探讨支架辅助栓塞前交通宽颈动脉瘤的术前评估、支架植入策略、治疗效果.方法 回顾分析采用支架结合弹簧圈治疗的21例前交通宽颈动脉瘤及载瘤动脉解剖形态,支架植入技术操作程序,临床和造影结果.结果 21例动脉瘤均成功植入支架,其中Neuroform支架19枚、LEO支架2枚.12例支架远端位于同侧A2段、5例支架远端越过前交通植入对侧A2段、4例位于动脉瘤内.术后即刻致密栓塞18例;大部分栓塞2例;部分栓塞1例.术中动脉瘤破裂1例,经继续栓塞后出血得到控制.平均8.7个月后DSA随访12例,MRA随访4例,显示1例动脉瘤再通.结论 术前应根据动脉瘤及前交通动脉的解剖形态和功能制定支架植入策略.支架辅助栓塞前交通宽颈动脉瘤技术安全可行,动脉瘤致密栓塞率高.支架的长期疗效需进一步随访观察.     

40例前交通动脉瘤脑血管造影特点分析

目的研究前交通动脉瘤的脑血管造影影像学特征，以提高该动脉瘤的手术疗效。方法总结我科近年来经手术证实的前交通动脉瘤40例脑血管造影影像学资料，选取76例其它非前交通动脉瘤的脑血管造影作为对照，探讨大脑前动脉一侧A1优势与前交通动脉瘤的关系；同时对前交通动脉瘤进行影像学分型。结果40例前交通动脉瘤脑血管造影片中，33例为一侧A1优势；对照组中有24例为一侧A1优势。前交通动脉瘤中前上型17例，前下型11例，后上型5例，后下型4例，复杂型3例。结论大脑前动脉一侧A1优势与前交通动脉瘤有密切的关系，对前交通动脉瘤的影像学分型有重要的临床意义。     

低位额部锁孔纵裂入路处理前交通动脉瘤

目的探讨采用“低位额部锁孔经纵裂入路”处理前交通动脉瘤的手术方法。方法沿发际前缘自然走行横行切开5cm,或取额部一较深的额纹,横行切开皮肤。在眉间上2.5cm处,铣一中线偏右侧的3cm×3.5cm游离小骨瓣。牵开右侧额叶和A2段,沿胼胝体膝部前缘到达前交通动脉。分离动脉瘤颈后选择合适的动脉瘤夹夹闭。结果18例病人中,术前Hunt分级Ⅰ级6例,Ⅱ级8例,Ⅲ级2例,Ⅳ级2例。术后恢复良好15例,迁延性昏迷1例,偏瘫1例,死亡1例。5例术后行DSA复查,无残留瘤颈。结论微创锁孔小骨窗行动脉瘤夹闭术是安全可行的,术者应对鞍上胼胝体区的显微解剖十分熟悉。     

前交通动脉动脉瘤的显微手术治疗

目的 探讨前交通动脉动脉瘤的外科治疗方法。方法 对2009年1月至2014年7月手术夹闭的121例前交通动脉瘤的临床资料进行回顾性分析,Hunt-Hess分级0级3例,Ⅰ级20例,Ⅱ级57例,Ⅲ级 29例,Ⅳ级12例。按动脉瘤瘤顶指向分类,前交通动脉瘤主要分为5型,向前12 例,向下13例,向上49例,向后23例,多方向24例。结果 121例138个前交通动脉瘤中,手术成功夹闭135个;2例（3个动脉瘤）手术夹闭困难,行动脉瘤包裹。有12例患者手术夹闭后由于脑积水而行脑室-腹腔分流术。出院时根据GOS评分判断预后:恢复良好101例,中残11例,重残5例,死亡4例（因手术后发生严重脑血管痉挛,顽固性颅内压增高而死亡）。结论 夹闭手术对于前交通动脉动脉瘤的治疗是安全有效的,入路主要以翼点入路为主,但手术夹闭要结合多种因素个体化对待。     

前循环动脉瘤破裂伴颅内血肿和脑疝患者的CT特点和直接手术疗效

目的 探讨前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现和直接手术疗效. 方法 回顾性分析四川省人民医院神经外科自2007年12月至2010年12月收治的11例前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现及治疗,分析前循环动脉瘤破裂形成血肿与动脉瘤位置关系及手术处理要点. 结果 本组患者颅内出血原因术中均证实为动脉瘤破裂出血,其中前交通动脉瘤2例,后交通动脉瘤3例,大脑中动脉瘤6例;多发动脉瘤2例,1例为大脑中动脉瘤(责任动脉瘤)合并同侧后交通动脉瘤,1例为后交通动脉瘤(责任动脉瘤)合并对侧大脑中动脉瘤:术后GOS分级显示V级6例,Ⅳ级2例,Ⅲ级1例,Ⅱ级0例,Ⅰ级2例. 结论 依据前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现,早期手术治疗效果满意.     

前交通动脉复合体的解剖学研究

目的通过在手术显微镜下对鞍区前交通动脉复合体及各自发出的穿支动脉的解剖和测量,进一步掌握和熟悉前交通动脉复合体的结构及毗邻血管神经的走行,为手术入路提供参考。方法在30侧(15例)福尔马林固定的成人湿性头颅标本上,模拟双侧翼点入路开颅,对鞍区前交通动脉复合体及各自发出的穿支动脉进行解剖观察和测量,所得结果用SPSS 10.0软件进行统计分析。结果描述和测量了前交通动脉复合体及其各分支、穿通动脉和神经的毗邻、走行及直径、长度。ACA均由前穿支下方的ICA发出对侧大脑前动脉借前交通动脉相接。回返动脉为ACA-A1段发出的穿动脉中最粗大的血管,起源部位、行程及数量变异大。ACoA的形态与双侧A1段直径关系密切。结论间隙Ⅱ中回返动脉起点范围通常位于前交通动脉近侧3 mm及前交通动脉远侧3 mm范围内,故在前交通动脉水平远、近侧3 mm范围内临时夹闭或解剖ACA时,易造成回返动脉损伤。在A1段近侧3~5 mm、A1段中1/3段少有穿支发出,此二处可作为ACoA动脉瘤手术时临时阻断的部位,而A1段远侧、特别在ACoA水平2 mm附近几乎均有回返动脉平行伴行,在此处解剖极易损伤回返动脉。A1段发育不全与ACoA动脉瘤可能有较高的相关性。     

Absent anterior communicating artery and varied distribution of anterior cerebral artery

During the cerebral dissection of a 67-year-old male cadaver, a unique combination of variations at the circle of Willis and anterior cerebral artery (ACA) distribution were encountered. The A1 segment of both ACA were fused without an anterior communicating artery (ACoA), forming an X shape and giving rise to a common pericallosal artery (CPA), an incomplete distal ACA, and an incomplete distal anterior cerebral artery (IACA). The IACA had an unusual course, which may be important from the surgical point of view. The CPA continued as the A2 and A3 segments, and bifurcated into 2 pericallosal arteries. Branching patterns of the varied arteries to the interhemispheric region were evaluated, and results were discussed. Additionally, both posterior communicating arteries were hypoplastic. There was no aneurysm formation at the circle of Willis and its branches.     

Ruptured distal anterior choroidal artery aneurysm

This report describes a patient with a rare distal anterior choroidal artery (AChoA) aneurysm that developed a right intracerebral haematoma and intraventricular haemorrhage and was treated by surgical exploration and clipping via a transtemporal/ventricular approach. The patient was discharged neurologically intact. We review the literature related to these rare aneurysms within the temporal horn, and the surgical anatomy of the AChoA.     

Dolichoectasic anterior cerebral artery and hemodynamics

Dolichoectasia of the intracranial arteries is a rare condition, and the vertebrobasilar system and the internal carotid artery are the most commonly involved structures. We report a rare case of idiopathic dolichoectasia of the anterior cerebral artery in a 22-year-old female. The patient caused an automobile accident and was brought to our hospital in an ambulance. A computed tomography scan and magnetic resonance imaging revealed no fresh lesions, but showed a prominent serpentine structure with calcification and flow void in the region of the interhemispheric fissure, which was suspicious for arteriovenous malformation or arteriovenous fistula. Cerebral angiography demonstrated extensive dilatation of the anterior cerebral artery, but no evidence of arteriovenous malformation or arteriovenous fistula. Single photon emission computed tomography revealed hypoperfusion of the right frontal lobe at rest. Electroencephalography showed no epileptic discharge. The patient's course was uneventful, and she was discharged with no neurologic deficit. There are few reports of hemodynamic changes in cases of dolichoectasia. In the diagnosis of cerebral dolichoectasia, cerebral hemodynamics should be examined carefully in addition to evaluating vascular disease by angiography.     

Aneurysms of the distal anterior cerebral artery

The clinical, angiographic and surgical features of 13 (out of 18) patients harboring pericallosal aneurysms and operated on by the same group of neurosurgeons, are analyzed. The mortality rate of the whole series was 5.5% with good (GOS II) or excellent (GOS I) recovery in the 91.7% of cases. According to the experience of the authors pericallosal aneurysms should not be considered to have a worse prognosis than aneurysms in other locations of the anterior circulation.     

MRI of anterior spinal artery syndrome.

In this serial MRI study a 24 year old man presenting anterior spinal artery syndrome was examined. In the acute stage, spin echo sequences showed an enlarged cervical cord on a T1 weighted image and high signal intensity in the enlarged portion of the cord on a T2 weighted image. The findings were interpreted as oedema in the grey and white matter subsequent to ischaemia. In the chronic stage, inversion recovery techniques revealed a distinct focus in the anterior two thirds of the cord at the low cervical level.     

椎-基底动脉开窗畸形合并同侧小脑前下动脉动脉瘤一例

患者女性,60岁。主因突发头痛3h,于2011年7月27日急诊入院。患者入院前3h无明显诱因突发剧烈头痛,以枕部明显,发作时无恶心、呕吐及听力异常。既往高血压病史1年余,平日不规律口服卡托普利,血压控制不详;无糖尿病病史。入院后体格检查:神志清楚、语言流利,应答准确;双侧瞳孔等大、等圆,直径约3mm,对光反射存在;颈项