前交通动脉瘤血管内栓塞治疗

目的总结以电解可脱性弹簧圈(GDC)血管内栓塞治疗前交通动脉瘤的技术要点、并发症及其防治经验,并评价其治疗效果.方法对46例前交通动脉瘤患者采用经皮股动脉穿刺行全脑选择性血管造影术,应用GDC进行动脉瘤囊内栓塞;术后早期处理出血并有效的对症治疗.结果成功栓塞46个动脉瘤,其中44例临床痊愈,2例死亡,死亡率4.3%.术中动脉瘤腔100%闭塞者41例,95%闭塞者3例,90%闭塞者2例.术中动脉瘤破裂1例,并发脑血栓1例,并发脑血管痉挛4例;术后无弹簧圈末端逸出,1例复发者经二次补充GDC栓塞而治愈.术后随访3～50个月均无再出血.结论对前交通动脉瘤采用GDC进行血管内囊内栓塞疗效可靠;早期诊断、早期治疗、正确处理术中并发症、提高栓塞技术及积极有效的术后处理是减少术后并发症、提高治愈率的重要方法.     

电解脱弹簧圈联合机械微弹簧圈治疗硬膜内出血性椎动脉夹层四例报道

目的 初步探讨电解脱弹簧圈联合机械微弹簧圈血管内治疗硬膜内出血性椎动脉夹层的疗效. 方法 选择日照市人民医院自2008年1月至2011年12月连续4例经DSA确诊的硬膜内出血性椎动脉夹层患者,病变均位于小脑下后动脉近端,结合影像学及临床资料评估后经血管内栓塞治疗.选用电解脱弹簧圈致密栓塞夹层段椎动脉,机械弹簧圈栓塞夹层近端椎动脉. 结果 术中未发生死亡、破裂出血及其它严重并发症,术后即刻造影检查4例椎动脉夹层均完全闭塞,随访6～36个月,未发生再出血及缺血等并发症. 结论 采用电解脱弹簧圈联合机械微弹簧圈血管内栓塞夹层段椎动脉治疗硬膜内出血性椎动脉夹层是安全、有效的,不仅有利于降低再出血率,还可降低手术费用.     

电解可脱性微弹簧圈栓塞治疗颅内动脉瘤

目的总结电解式可脱性微弹簧圈（ＧＤＣ）栓塞治疗颅内动脉瘤的经验。方法１９９８年２月至１９９８年８月用ＧＤＣ栓塞治疗颅内动脉瘤５６例,其中蛛网膜下腔出血（ＳＡＨ）急性期病例１３例。术前Ｈｕｎｔ氏分级;７例为Ⅳ级,１４例为Ⅲ级,３５例为Ⅰ－Ⅱ级。采用美国ＢｏｓｔｏｎＳｃｉｅｎｔｉｆｉｃＣｏ．的ＧＤＣ进行栓塞治疗。结果５６例栓塞后无死亡及永久并发症,有２例前交通动脉瘤栓塞后出现一过性偏瘫,经内科治疗１周,症状、体征消失。５６例中４４例造影证实为完全闭塞,有８例为大部分闭塞。本组由于治疗时间均在半年内,无随访资料。结论ＧＤＣ栓塞治疗动脉瘤,是目前比较理想的治疗方法,但其远期疗效有待随访观察。     

前交通动脉瘤的显微手术治疗

目的介绍翼点入路治疗前交通动脉瘤的手术经验，提高手术疗效。方法回顾性分析56例前交通动脉瘤病人的临床表现、影像资料、手术治疗及预后情况。56例均行直接夹闭术，1例加做包裹术。结果治愈或良好47例，致残8例，死亡1例。随访5个月～3年，无动脉瘤再出血发生。结论翼点入路手术治疗前交通动脉瘤显露充分、术式成熟、并发症少，配合多种外科技术如临时阻断的应用、脑保护、控制性低血压等，可收到满意的手术疗效。     

血管内治疗前交通动脉瘤

目的 总结前交通动脉瘤血管内治疗的经验和体会,探讨血管内治疗前交通动脉瘤的效果和减少并发症发生的方法.方法 共栓塞前交通动脉瘤98例.依据Hunt-Hess分级:I级16例,Ⅱ级52例,Ⅲ级23例,Ⅳ级7例.术后积极行腰大池或腰穿引流血性脑脊液,采用3H疗法防治血管痉挛.结果 98个动脉瘤全部成功栓塞,随访3个月-3年,无再出血发生.结论 血管内治疗前交通动脉瘤是一种有效、确切的治疗方法.术后早期引流血性脑脊液、积极药物治疗是减少并发症的发生、提高治疗效果的重要方法.     

Blister-like aneurysm of the anterior communicating artery

We report a recent experience with a blister-like aneurysm of the anterior communicating artery and suggest that this entity may be responsible for so-called non-aneurysmal haemorrhage when the distribution of blood is atypical.     

Amnesia after anterior communicating artery aneurysm rupture

We studied 11 patients with amnesia and personality change after surgical repair of ruptured anterior communicating artery ( ACoA ) aneurysm. CT and clinical evidence suggested that infarction in the territory of the ACoA was responsible for amnesia and personality change. The medial septal nuclei, the paraventricular nucleus of the anterior hypothalamus, and the medial forebrain bundle are the primary areas of potential interest in these cases. Gross infarction in the frontal lobes is not a requirement for the syndrome.     

Penetration and splitting of the optic apparatus by intrasaccular coils within an anterior communicating artery aneurysm

Penetration of the optic apparatus by an anterior communicating artery (ACoA) aneurysm is unique. A 43-year-old woman with a history of visual disturbance due to a previous aneurismal rupture underwent surgical neck clipping for a recurred ACoA aneurysm, which had previously been treated using detachable coils. The operation confirmed that the recurred aneurysm and the packed coils had penetrated the chiasm and the right optic nerve (ON), which was distorted and thinned. The aneurismal neck was clipped and the coils were left in place because damage to the optic apparatus by penetration is usually irreversible. As the patient was semicomatous at the former admission due to subarachnoid hemorrhage (SAH), she became aware of the visual disturbance 2 weeks after ictus when she had improved enough to communicate. The visual disturbance was found to have gradually improved at her 1-year follow-up. The absence of visual symptoms before the SAH and gradual visual improvement after coiling, even after recurrence due to coil compaction, were considered more compatible with a chronic compensated compressive, penetrating lesion of the ON.     

Spontaneous subarachnoid haemorrhage from rupture of an anterior communicating artery aneurysm in a patient with pituitary macroadenoma

The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time.The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject.     

Memory performances after anterior communicating artery aneurysm surgery

10 patients operated on for anterior communicating artery aneurysm (ACoA) underwent to neuropsychological examination one year after surgery, in order to detect eventual behavioural and/or amnestic disorders, already described by others in a wide percentage of such patients. Even if after accurate neurological examination the therapeutic results were defined as "good", 60% circa of our patients present amnestic and/or behavioural disturbances. Possible correlations between neuropsychological tests finding and intraoperative occurrences (early aneurysm rupture, gyrectomy etc.) are considered and discussed.     

Confabulation following aneurysm of the anterior communicating artery.

Nine subjects with aneurysms of the anterior communicating artery (ACoA) and 17 subjects with other intracranial hemorrhages (ICH) were evaluated for confabulatory responses under two naturally occurring conditions: (1) when subjects were not oriented to person, place, month and year, (2) when subjects were fully oriented. Confabulation was observed in all 9 of ACoA patients both during disoriented and oriented periods. In contrast, 7/17 of the other ICH patients showed signs of confabulation while disoriented, whereas only one continued to display confabulatory tendencies while fully oriented. Confabulation was more severe in the ACoA group. These data suggest that the confabulation observed in the other ICH group may be secondary to an acute confusional state while the prolonged confabulation in ACoA patients may be a manifestation of a more primary cerebral disorder.     

Cognitive dysfunction after aneurysm of the anterior communicating artery

Abstract

The present study examined the nature of the amnestic syndrome following aneurysm of the anterior communicating artery (ACoA) in humans. Eleven ACoA and 13 subjects with intracranial hemorrhages (ICH) elsewhere in the brain were administered a battery of standard neuropsychological tests. The ACoA group performed significantly worse than the ICH controls on tests of delayed verbal memory and on the Wisconsin Card Sorting Test, despite significantly higher Full Scale IQ. No significant differences were observed between groups on tests of immediate recall, attention and concentration, and visuo-spatial functions, although the ACoA group tended to perform better on many of these tests. The results do not support the hypothesis that the cognitive impairments observed following ACoA aneurysm are the result of diffuse cortical damage. The role of specific anterior cerebral structures in defining the “ACOA syndrome” are discussed.     

重症前交通动脉瘤的手术夹闭治疗

目的总结14例重症前交通动脉瘤的夹闭治疗经验。方法 14例前交通动脉瘤破裂破入脑室的病例中,Hunt-Hess分级Ⅳ12例,Ⅴ级2例。诊断明确后先行脑室外引流术,而后再经翼点入路行动脉瘤夹闭术,观察其治疗结果,采用GOS评分进行判断预后。结果 GOS5分者9例,GOS4分者2例,GOS3分者2例,GOS1分者1例。结论对于前交通动脉瘤破裂岀血并破入脑室的危重患者,早期给予手术治疗时先给予行脑室外引流术再行颅内动脉瘤夹闭术是挽救前交通动脉瘤破裂岀血并破入脑室的危重患者的成功关键。     

Proactive interference in patients with amnesia resulting from anterior communicating artery aneurysm

Abstract

Diencephalic and temporal amnesics display an excessive sensitivity to proactive interference (PI) in memory tasks of the AB/AC kind. There exists considerable controversy about the nature of this sensitivity to PI. Moreover, it is an open question whether such sensitivity to PI is an obligatory feature of amnesia, or rather an incidental result of frontal damage often reported in amnesics. This question was reexamined by enrolling patients with an operated aneurysm of the anterior communicating artery (ACoA) and matched controls for an AB/AC learning task of two lists of 12 paired-associate words. It appeared that ACoA patients, like diencephalic and temporal amnesics, did indeed display a marked sensitivity to PI when compared to normals (Exp. I), even when performance of both groups in the learning of the first list was equated (Exp. II). The distribution of errors made in learning the second list, as well as the correlations between performance in learning the second list and a Stroop test, suggest that sensitivity to PI in ACoA amnesics could be the consequence of an inability to suppress irrelevant information at retrieval due to defective inhibitory attentional mechanisms. Complementary data collected in a small sample of Korsakoff's amnesic subjects are also described.     

Neuropsychological deficits after surgical repair of anterior communicating artery aneurysm

Based on the review of literature we tried to establish the pattern and dynamic of psychoneurological disturbances as a result of rupture and surgical procedures of anterior communicating artery (ACoA) aneurysm in three aspects: pathoanatomy, pathophysiology and rehabilitation. Anterior communicating artery syndrome (amnesia, confabulation, personality changes) was observed in very few patients, especially in those after clipping of an anterior communicating artery (trapping). Mostly neuropsychological pattern consisted of anterograde memory problems, executive dysfunctions, global attention impairments, confabulations and personality changes. Neuropsychological deficits observed in ACoA patients were probably a result of basal forebrain lesions. The precise analysis of the disturbances is necessary especially in the early stage. Proper cognitive rehabilitation of attention and memory functions is recommended to improve professional and daily living activities.     

Anatomy of executive deficit following ruptured anterior communicating artery aneurysm

Background and purpose: To evaluate behavioral and cognitive deficits following anterior communicating artery aneurysm rupture and determine critical lesion locations. Methods: We investigated 74 patients with standardized cognitive tests and behavioral inventory. Two examiners rated MRI signal abnormalities in 51 predetermined regions of interest. Classification tree analysis was used to select regions associated with each cognitive deficit. Results: Eleven patients presented behavioral executive deficits and 10 had cognitive executive deficit. Their presence depended on left hemisphere lesions only: (i) ventral striatum lesion was associated with behavioral executive deficit (P = 0.04), reduction of activities (P = 0.01), and hyperactivity (P = 0.02); (ii) superior frontal gyrus lesion, with cognitive executive deficit (P = 0.01), action initiation deficit (P = 0.02), and rule deduction deficit (P = 0.02); (iii) anterior half of centrum semiovale lesion, with Stroop inhibition deficit (P = 0.02); (iv) medial superior and middle frontal gyri lesions, with task coordination deficit (P = 0.01); and (v) middle frontal gyrus lesion, with words generation deficit (P = 0.02). Conclusion: This study supports that (i) cognitive executive deficits depend mostly on lateral prefrontal lesions, (ii) with locations varying according to executive process, and (iii) behavioral executive deficits are mainly due to left ventral striatum lesion in post‐aneurysmal damage.     

Cognitive dysfunction after aneurysm of the anterior communicating artery.

The present study examined the nature of the amnestic syndrome following aneurysm of the anterior communicating artery (ACoA) in humans. Eleven ACoA and 13 subjects with intracranial hemorrhages (ICH) elsewhere in the brain were administered a battery of standard neuropsychological tests. The ACoA group performed significantly worse than the ICH controls on tests of delayed verbal memory and on the Wisconsin Card Sorting Test, despite significantly higher Full Scale IQ. No significant differences were observed between groups on tests of immediate recall, attention and concentration, and visuo-spatial functions, although the ACoA group tended to perform better on many of these tests. The results do not support the hypothesis that the cognitive impairments observed following ACoA aneurysm are the result of diffuse cortical damage. The role of specific anterior cerebral structures in defining the "ACOA syndrome" are discussed.     

经纵裂间入路治疗破裂前交通动脉瘤

目的 探讨经纵裂间入路治疗破裂前交通动脉瘤的临床疗效. 方法 中国医科大学附属第一医院神经外科神经血管病病房自2008年1月至2009年8月采用经纵裂间入路治疗破裂前交通动脉瘤患者23例,回顾性分析患者的临床资料及手术效果. 结果 动脉瘤均成功夹闭,其中3例动脉瘤术中破裂出血,8例夹闭动脉瘤颈后切除动脉瘤.所有患者术后1 d及出院时头部CT证实无脑积水和脑组织缺血梗死发生.术后第3天行经颅多普勒超声检查提示有5例患者出现脑血管痉挛,其中2例患者出现额叶精神症状,1周后恢复.本组无手术致残及死亡者. 结论 经纵裂间入路可以充分显露前交通复合体、动脉瘤颈并夹闭前交通动脉瘤,同时可以清除血肿,减轻术后血管痉挛,临床效果令人满意.