Nishioka Hiroshi, Haraoka Jo, Miki Tamotsu, Akimoto Jiro, Yamanaka Shigeto, Hasegawa Koichi, Matsumura Hiroyuki
Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
No Shinkei Geka. 2003 Jan;31(1):27-33.
In contrast to aneurysms of the middle cerebral artery at the bifurcation, aneurysms at the origin of the lenticulostriate arteries (LSA) are uncommon. Six surgically treated patients (34 to 70 year-old; 3 men, 3 women) were reviewed. 5 patients presented with subarachnoid hemorrhage (H&H grade 2:3, 3:1, 4:1; Fisher type 2:1, 3:3, 4:1) and 2 patients had multiple aneurysms. All aneurysms arose from the postero-superior surface of the M1. Although neck clipping was achieved in every patient, re-application of the clip was necessary during surgery in 3 patients because the tip of the blade extended to the other perforators that ran parallel to the M1. Results were as follows: GR 3, MD1, SD 1, D1. Apart from a 70 year-old patient who died of vasospasm (H & H 4), fair results in two patients were accompanied by ischemic complications of the LSA. All 3 patients who required re-application of the clip during surgery showed a lacunar infarct of perforating arteries on post-operative CT. Special care of perforating arteries not only around the neck (the LSA) but also behind the aneurysm is essential for successful neck-clipping of aneurysms at this location.
与大脑中动脉分叉处的动脉瘤不同，豆纹动脉（LSA）起始部的动脉瘤并不常见。回顾了6例接受手术治疗的患者（年龄34至70岁；男性3例，女性3例）。5例患者表现为蛛网膜下腔出血（H&H分级2级：3例，3级：1例，4级：1例；Fisher分型2型：1例，3型：3例，4型：1例），2例患者有多个动脉瘤。所有动脉瘤均起源于M1段的后上表面。尽管每位患者均成功夹闭了瘤颈，但3例患者在手术过程中需要重新夹闭，因为刀片尖端延伸至与M1段平行的其他穿支血管。结果如下：良好3例，中等1例，差1例，死亡1例。除1例70岁患者死于血管痉挛（H&H 4级）外，2例患者预后尚可，但伴有LSA的缺血性并发症。所有3例手术中需要重新夹闭瘤颈的患者术后CT均显示穿支动脉腔隙性梗死。对于在此部位成功夹闭动脉瘤，不仅要特别注意瘤颈周围（LSA）的穿支动脉，还要注意动脉瘤后方的穿支动脉。
