Takeshita M, Kubo O, Onda H, Nagao T, Kawamata T, Uchinuno H, Nitta M, Yamamura K, Kagawa M
Department of Neurosurgery, Neurological Institute Tokyo Women's Medical College.
No Shinkei Geka. 1991 Sep;19(9):871-6.
A ruptured anterior cerebral artery aneurysm with anomalous right infraoptic course of the anterior cerebral artery (ACA) was reported. A 40-year old male was admitted because of SAH episode, and computerized tomography (CT) on the day of admission revealed hemorrhage in both Sylvian and interhemispheric fissures. Four-vessel angiography was performed on the same day. A saccular aneurysm was demonstrated in the region of the anterior communicating artery (ACoA), and anomalous artery, which originated from the intradural right carotid artery at the level of the right ophthalmic artery was found to be running medially and superiorly. It supplied the bilateral callosomarginal arteries and the unpaired pericallosal artery. The fenestration of the vertebral artery, duplication of bilateral superior cerebellar arteries, and an occipital artery arising from the right internal carotid artery at the C3 level were found. Surgery was performed on the first day of admission, and the anterior interhemispheric approach was selected. The anomalous branch of the right ICA ran beneath the right optic nerve, ascended between the optic nerves, and supplied the ACoA system. The left hypoplastic A1 segment entered the ACoA. However, the right A1 segment could not be found. The aneurysmal neck, situated between the bilateral callosomarginal arteries and the unpaired pericallosal artery, was clipped with Sugitas curved clip. The postoperative course was uneventful and a follow-up angiograph revealed successful obliteration of the aneurysm.
报告了一例大脑前动脉动脉瘤破裂，同时大脑前动脉（ACA）走行异常，呈右侧视交叉下路径。一名40岁男性因蛛网膜下腔出血发作入院，入院当天的计算机断层扫描（CT）显示外侧裂和大脑半球间裂均有出血。同日进行了全脑血管造影。在前交通动脉（ACoA）区域发现一个囊状动脉瘤，还发现一条异常动脉，起源于右侧眼动脉水平的硬脑膜内右颈动脉，向内上方走行。它供应双侧胼周动脉和不成对的胼缘动脉。发现椎动脉开窗、双侧小脑上动脉重复以及右侧枕动脉在C3水平起源于右颈内动脉。入院第一天进行了手术，选择了经大脑半球间前入路。右颈内动脉的异常分支走行于右视神经下方，在视神经之间上升，并供应ACoA系统。左侧A1段发育不全，进入ACoA。然而，未发现右侧A1段。位于双侧胼缘动脉和不成对的胼周动脉之间的动脉瘤颈，用杉田弯夹夹闭。术后病程平稳，随访血管造影显示动脉瘤成功闭塞。
