Saito Takafumi, Kurashima Akihiko, Yamashita Shinya, Honma Junpei, Nishikawa Tarou, Natsumeda Manabu
Department of Neurosurgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano 380-8582, Japan.
No Shinkei Geka. 2007 Sep;35(9):881-5.
Relationships between hypothalamic arteries and anterior communicating artery aneurysms were examined in 34 cases treated by clipping operations, using the anterior interhemispheric approach. The directions of the aneurysmal domes and hypothalamic arteries were analyzed and divided into 2 groups. The different direction (D.D.) group involved cases in which a hypothalamic artery ran in a different direction to that of the dome of the aneurysm. The same direction (S.D.) group involved cases in which a hypothalamic artery ran parallel to the dome of the aneurysm. The D.D. group consisted of 15 cases, and the S.D. group consisted of 13 cases. In the remaining 6 cases, the hypothalamic artery was not found during the operation. In many cases of the D.D. group, the aneurysm was located anterior to the A2 portions of the bilateral anterior cerebral arteries, whereas, in all cases of the S.D. group, the aneurysm was located between or posterior to the bilateral A2 portions. We also investigated the flow direction of the anterior communicating artery in the S.D. group. The dominant A1 was defined as the side of internal carotid angiography in which the aneurysm was depicted on preoperative angiography. The flow direction of the anterior communicating artery was assumed to flow from the dominant A1 side to the recessive A1 side. Considering the flow direction of the anterior communicating artery, the hypothalamic artery was located downstream from the aneurysm in 9 cases and upstream in 3 cases. These results suggested that it is important to pay more attention to the downstream of the aneurysm to avoid injury of the hypothalamic artery in the S.D. group. For cases in which the hypothalamic artery was located upstream to the aneurysm, these aneurysms seemed to arise from the bifurcation of the anterior communicating artery and hypothalamic artery, and might be named hypothalamic artery aneurisms.
采用经半球间前入路，对34例行夹闭手术治疗的病例中下丘脑动脉与前交通动脉瘤的关系进行了研究。分析了动脉瘤瘤顶与下丘脑动脉的走行方向，并将其分为两组。不同方向（D.D.）组包括下丘脑动脉走行方向与动脉瘤瘤顶不同的病例。相同方向（S.D.）组包括下丘脑动脉与动脉瘤瘤顶平行走行的病例。D.D.组有15例，S.D.组有13例。其余6例在手术中未发现下丘脑动脉。在D.D.组的许多病例中，动脉瘤位于双侧大脑前动脉A2段的前方，而在S.D.组的所有病例中，动脉瘤位于双侧A2段之间或后方。我们还研究了S.D.组前交通动脉的血流方向。优势A1定义为术前血管造影显示动脉瘤的颈内动脉造影侧。假定前交通动脉的血流方向是从优势A1侧向劣势A1侧流动。考虑到前交通动脉的血流方向，下丘脑动脉在9例中位于动脉瘤的下游，在3例中位于上游。这些结果表明，在S.D.组中，为避免损伤下丘脑动脉，更应关注动脉瘤的下游。对于下丘脑动脉位于动脉瘤上游的病例，这些动脉瘤似乎起源于前交通动脉与下丘脑动脉的分叉处，可能应称为下丘脑动脉动脉瘤。
