Czepko R, Libionka W, Lopatka P
Department of Neurosurgery, Institute of Neurology, Collegium Medicum of the Jagiellonian University Cracow, Poland.
J Neurosurg Sci. 2005 Sep;49(3):85-95.
Proximal anterior cerebral artery (A1) aneurysms are considered to be rare or even unique. Proper surgical planning around A1 segment is particularly essential in order to avoid injury of tiny perforating arteries.
In 17 patients with angiographically or intraoperatively diagnosed A1 aneurysms, representing 0.8% of 2 124 aneurysm patients treated surgically at our institution between 1991 and 2003, clinical presentation, neuroradiological findings, surgical treatment methods and outcome were retrospectively analyzed.
Sixteen patients presented with subarachnoid hemorrhage; A1 aneurysms were ruptured in 13 cases. Five patients (29%) had multiple aneurysms. In all cases A1 aneurysms were saccular and their maximum diameter ranged from 4 to 25 mm, average, 7.2 mm; in 4 cases they projected from the origin of the perforating artery, in 6 at the bifurcation of the internal carotid artery, in 5 at the anterior communicating artery and in 2 from the convexity of the parent artery. In 15 patients aneurysms were clipped via ipsilateral pterional approach and in the remaining 2, including a case with a second middle cerebral artery aneurysm, through contralateral approach. Eleven patients had excellent outcome, three good, and three died.
Angiograms must be thoroughly analyzed to correctly assess origin of the aneurysmal neck, and to plan the operative procedure as radiological presentations of distal or proximal A1 lesions resemble those of anterior communicating artery and internal carotid artery bifurcation aneurysms, respectively. Contralateral approach may facilitate surgical elimination of selected A1 aneurysms or enable one-stage clipping in patients with multiple bilateral aneurysms.
大脑前动脉近端（A1）动脉瘤被认为较为罕见甚至独特。围绕A1段进行恰当的手术规划对于避免损伤微小的穿支动脉尤为重要。
回顾性分析17例经血管造影或术中诊断为A1动脉瘤的患者，这些患者占1991年至2003年间在我院接受手术治疗的2124例动脉瘤患者的0.8%，分析其临床表现、神经放射学检查结果、手术治疗方法及预后。
16例患者表现为蛛网膜下腔出血；13例A1动脉瘤破裂。5例患者（29%）有多发动脉瘤。所有病例中，A1动脉瘤均为囊状，最大直径为4至25毫米，平均7.2毫米；4例动脉瘤从穿支动脉起源处突出，6例在颈内动脉分叉处，5例在前交通动脉，2例从母动脉凸面发出。15例患者通过同侧翼点入路夹闭动脉瘤，其余2例，包括1例合并大脑中动脉第二个动脉瘤的患者，通过对侧入路夹闭。11例患者预后良好，3例较好，3例死亡。
必须全面分析血管造影，以正确评估动脉瘤颈的起源，并规划手术操作，因为A1段远端或近端病变的放射学表现分别类似于前交通动脉和颈内动脉分叉处动脉瘤的表现。对侧入路可能有助于手术切除某些A1动脉瘤，或使双侧多发动脉瘤患者能够一期夹闭。
