Moon Hyung Sik, Kim Tae Sun, Joo Sung-Pil
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
J Korean Neurosurg Soc. 2012 Nov;52(5):501-4. doi: 10.3340/jkns.2012.52.5.501. Epub 2012 Nov 30.
To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping.
A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant (30×18 mm sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow.
Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.
报告我们使用原位端侧旁路手术治疗不适用于显微手术夹闭的巨大蜿蜒型大脑前动脉远端动脉瘤的手术经验。
一名49岁女性，出现头痛和间歇性意识丧失。脑部计算机断层扫描显示半球间裂有部分钙化肿块。脑血管造影显示，这是一个巨大的（大小为30×18毫米）、蜿蜒型动脉瘤，起源于大脑前动脉远端（DACA）的A2至A3段。用夹子夹闭动脉瘤，并进行了DACA右A3段至左A3段的原位端侧旁路手术。手术结果良好，急性恢复期未出现新的缺血事件。术后血管造影显示动脉瘤完全闭塞且通畅良好，远端血流得以保留。
DACA的巨大梭形动脉瘤极为罕见，治疗极具挑战性。A3:A3端侧旁路联合动脉瘤夹闭可能是这些部位的一种治疗方式。
