Taylor R, Connolly E S, Duong H
Department of Radiology, Neurological Institute, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Neurosurgery. 2000 Feb;46(2):482-4. doi: 10.1097/00006123-200002000-00042.
True duplication of the A1 segment of the anterior cerebral artery is extremely rare, as is finding a true A1 segment saccular aneurysm. We report the angiographic and surgical findings of such a case with the additional association of a hypoplastic ipsilateral M1 segment of the middle cerebral artery.
A 68-year-old man presented with a Hunt and Hess Grade II subarachnoid hemorrhage and symptoms of headache, nuchal rigidity, and facial paresis.
Angiographic evaluation with superselective exploration revealed a small ruptured aneurysm located on a duplicated hypoplastic A1 segment of the left anterior cerebral artery with associated middle cerebral artery stenosis and secondary early moyamoya changes. Surgical clipping of the aneurysm was performed successfully while sparing the hypoplastic A1 segment.
A1 aneurysms occurring on a duplicated anterior cerebral artery segment probably develop from a congenital weakness of the parent vessel and increased local shear stress. Superselective angiography was helpful in the preoperative planning and facilitated the decision to treat with surgical clipping instead of embolization.
大脑前动脉A1段真正的重复极为罕见，发现真正的A1段囊状动脉瘤同样罕见。我们报告了这样一例病例的血管造影及手术结果，该病例还伴有同侧大脑中动脉M1段发育不全。
一名68岁男性，表现为Hunt和Hess分级II级蛛网膜下腔出血，伴有头痛、颈项强直和面部轻瘫症状。
超选择性探查血管造影评估显示，一个小的破裂动脉瘤位于左侧大脑前动脉重复且发育不全的A1段，伴有大脑中动脉狭窄及继发性早期烟雾病改变。成功实施了动脉瘤夹闭手术，同时保留了发育不全的A1段。
发生在大脑前动脉重复段的A1动脉瘤可能源于母血管的先天性薄弱及局部剪切力增加。超选择性血管造影有助于术前规划，并有助于决定采用手术夹闭而非栓塞治疗。
