Department of Neurosurgery, Chonbuk National University Hospital & Medical School, Chonju, Korea.
World Neurosurg. 2010 Oct-Nov;74(4-5):478-82. doi: 10.1016/j.wneu.2010.06.040. Epub 2011 Jan 12.
To report a series of 20 consecutive patients with aneurysms of the proximal segment (A1) of the anterior cerebral artery (ACA.
The medical records of patients who had undergone surgery for intracranial aneurysms at two institutions between January 1, 1989, and February 1, 2009, were reviewed. Mean patient age was 52.15 years (range 39-69 years). All 20 patients underwent direct surgery, with clipping or trapping, via standard pterional craniotomy.
The incidence of A1 segment aneurysm was 0.59%. There were 16 women and 4 men, showing a strong predominance of this lesion in women. Mean aneurysm size was 6.95 mm (range 3-10 mm). Four patients (20%) had multiple aneurysms, and three patients (15%) had associated vascular anomalies. Among patients whose aneurysms originated from perforating arteries, dissection sacrificed the perforating arteries in two patients, and the perforating arteries occluded postoperatively in three patients. In the patients whose aneurysms did not originate from perforating arteries, no perforating arteries were sacrificed during dissection, and perforating arteries became occluded in two patients postoperatively. There was no statistically significant difference between the two groups of patients regarding the incidence of injury or occlusion. Clinical outcomes were as follows: good recovery in 15 (75%) patients, moderate disability in 2 (10%) patients, severe disability in 2 (10%) patients, and death in 1 (5%) patient.
The important consideration in surgery for intracranial aneurysms is preservation of the perforating arteries, through cautious dissection around the neck or dome and avoidance of direct clip compression, even after releasing the retracted frontal lobe.
报告 20 例连续的大脑前动脉（ACA）近端（A1）段动脉瘤患者系列。
回顾了 1989 年 1 月 1 日至 2009 年 2 月 1 日期间在两个机构接受颅内动脉瘤手术的患者的病历。患者平均年龄为 52.15 岁（范围 39-69 岁）。所有 20 例患者均通过标准翼点开颅术进行直接手术，夹闭或夹闭。
A1 段动脉瘤的发生率为 0.59%。有 16 名女性和 4 名男性，女性对此病变的优势明显。平均动脉瘤大小为 6.95 毫米（范围 3-10 毫米）。4 例（20%）有多发动脉瘤，3 例（15%）有血管畸形相关。在起源于穿支动脉的患者中，2 例夹层术牺牲了穿支动脉，3 例术后穿支动脉闭塞。在起源于非穿支动脉的患者中，夹层术时未牺牲穿支动脉，2 例术后穿支动脉闭塞。两组患者在损伤或闭塞的发生率方面无统计学差异。临床结果如下：15 例（75%）患者恢复良好，2 例（10%）患者中度残疾，2 例（10%）患者重度残疾，1 例（5%）患者死亡。
颅内动脉瘤手术的重要考虑因素是通过在颈部或穹窿周围小心地进行解剖，避免直接夹闭，即使在额叶回缩后，也要保护穿支动脉。
