Mercado Marcos, de Jesús Orlando
Department of Surgery, Neurosurgery Section, Medical Sciences Campus, University of Puerto Rico, GPO Box 5067, San Juan, P.R. 00936.
P R Health Sci J. 2003 Dec;22(4):405-8.
The purpose of this paper is to describe the occurrence of bilobulated aneurysms at the origin of the posterior communicating artery.
Bilobulated aneurysms at the origin of the posterior communicating artery from the internal carotid artery are rarely reported in the literature. A review of the literature showed only one report in which this type of aneurysm was addressed.
A consecutive series of 85 aneurysms operated by a single surgeon in 75 patients during an eight-year period (March 1995-February 2003) at the University Hospital was reviewed retrospectively. The incidence, radiological findings, intraoperative findings, surgical treatment and outcome of patients with bilobulated aneurysms at the origin of the posterior communicating artery were analyzed. The pathophysiologic mechanism for the formation of the bilobulated aneurysm was analyzed for each case.
Thirty-two aneurysms (37.6%) located at the origin of the posterior communicating artery were operated. Four patients who had angiographic evidence of a bilobulated aneurysm at the origin of the posterior communicating artery were identified and operated. Among those four patients, only three had a bilobulated aneurysm. In one patient, microsurgical exploration revealed the presence of two consecutive aneurysms originating from the posterior communicating artery. The incidence of bilobulated aneurysms at the origin of the posterior communicating artery was 9.4%. One patient died during the postoperative period for a 25% mortality rate.
The incidence of this type of aneurysm is low; therefore, they represent a technical challenge to the neurosurgeon.
本文旨在描述后交通动脉起始处双叶状动脉瘤的发生情况。
文献中很少报道源自颈内动脉的后交通动脉起始处的双叶状动脉瘤。文献回顾显示仅有一篇报道涉及此类动脉瘤。
回顾性分析了一位外科医生在大学医院八年期间（1995年3月至2003年2月）为75例患者实施的连续85例动脉瘤手术。分析了后交通动脉起始处双叶状动脉瘤患者的发病率、影像学表现、术中所见、手术治疗及预后。对每例双叶状动脉瘤形成的病理生理机制进行了分析。
对位于后交通动脉起始处的32例动脉瘤（37.6%）进行了手术。确定并手术治疗了4例有后交通动脉起始处双叶状动脉瘤血管造影证据的患者。在这4例患者中，只有3例有双叶状动脉瘤。1例患者经显微手术探查发现有两个连续的源自后交通动脉的动脉瘤。后交通动脉起始处双叶状动脉瘤的发病率为9.4%。1例患者术后死亡，死亡率为25%。
此类动脉瘤的发病率较低；因此，它们对神经外科医生来说是一项技术挑战。
