Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):407-15. doi: 10.1227/NEU.0b013e3181faaa45.
Fusiform anterior communicating artery (ACoA) aneurysms (ACoAAs) are rare, and a series of these aneurysms has not been reported. Large fusiform ACoAA are easily identifiable, whereas smaller ones can coexist with a saccular component.
To provide a clear-cut definition, report the incidence of these aneurysms, present a series with follow-up data, and discuss operative nuances and clip application techniques.
Review of a single-surgeon operative series of all ACoAAs to identify fusiform types. When A1 or A2 vessels entered or arose from the ACoAA, it was classified as fusiform. Follow-up imaging and clinical progress were noted.
Five fusiform ACoAAs were identified. Patient age ranged from 19 to 68 years. Anatomy varied from very obvious large fusiform, to identifiable fusiform nature with a saccular component, to an irregularly shaped aneurysm with a fusiform element of the ACoA. A large fusiform aneurysm reconstructed in 1 patient recurred 11 years later as a ruptured fusiform ACoAA that was reconstructed again. One patient had a giant thrombosed aneurysm with thrombosed vessels in which A2 reconstruction was attempted with sacrifice of the ACoA. In others, simple clipping achieved obliteration of the aneurysm together with creating a normal dimension ACoA. There were no operative deaths; other than rupture intraoperatively, no other complications occurred. Postoperatively, no patient had new neurological deficits, 3 had short-term memory loss, and all were ambulatory with good speech function.
Review of angiograms and 3-dimensional computed tomography angiography reconstruction images can identify the complex and fusiform entity of ACoAA, which is important for preoperative planning. Experience in operative techniques and thorough knowledge of the ACoA anatomy are cornerstones to obliterate the aneurysm, maintain flow in all vessels, and surgically create an ACoA of normal caliber.
梭形前交通动脉瘤（ACoAA）较为罕见，尚未见此类动脉瘤的系列报道。大的梭形 ACoAA 很容易识别，而较小的动脉瘤可能与囊状成分共存。
提供明确的定义，报告此类动脉瘤的发生率，展示一系列具有随访数据的病例，并讨论手术细节和夹闭应用技术。
回顾单外科医生手术系列中的所有 ACoAA，以确定梭形类型。当 A1 或 A2 血管进入或起源于 ACoAA 时，将其归类为梭形。记录随访影像学和临床进展。
共发现 5 例梭形 ACoAA。患者年龄 19 岁至 68 岁。解剖结构从明显的大型梭形，到可识别的囊状成分梭形，到 ACoA 呈不规则形状的动脉瘤，都有不同表现。1 例大型梭形动脉瘤在 11 年后复发，成为破裂的梭形 ACoAA，再次进行重建。1 例患者有巨大的血栓形成动脉瘤，伴有血栓形成的血管，试图通过牺牲 ACoA 来重建 A2。在其他病例中，单纯夹闭即可使动脉瘤闭塞，并使 ACoA 恢复正常大小。无手术死亡；除术中破裂外，无其他并发症。术后，无患者出现新的神经功能缺损，3 例患者出现短期记忆丧失，所有患者均能行走，言语功能良好。
对血管造影和三维 CT 血管造影重建图像进行回顾可以识别 ACoAA 的复杂和梭形实体，这对于术前规划很重要。熟练的手术技术和对 ACoA 解剖结构的深入了解是闭塞动脉瘤、保持所有血管通畅以及手术创建正常口径 ACoA 的基石。
