Kwon Woo-Keun, Park Kyung-Jae, Park Dong-Hyuk, Kang Shin-Hyuk
Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2013 May;53(5):293-6. doi: 10.3340/jkns.2013.53.5.293. Epub 2013 May 31.
The aneurysm arising from fenestrated proximal anterior cerebral artery (ACA) is considered to be unique. The authors report a case of a 59-year-old woman who presented with a subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm originating from the fenestrated A1 segment of right ACA. The patient had another unruptured aneurysm which was located at the right middle cerebral artery bifurcation. She was successfully treated with surgical clipping for both aneurysms. From the previously existing literatures, we found 18 more cases (1983-2011) of aneurysms associated with fenestrated A1 segment. All cases represented saccular type of aneurysms, and 79% of the patients had SAH. There were three subtypes of the fenestrated A1 aneurysms depending on the anatomical location, relative to the fenestrated segment. The most common type was the aneurysms located on the proximal end of fenestrated artery (82%). Azygos ACA and hypoplastic A1 were frequently accompanied by the aneurysm (33% and 31%, respectively), and multiple aneurysms were shown in three cases (16%). Considering that fenestrated A1 segment is likely to develop an aneurysm, which has high risk of rupture, early management may benefit patients with aneurysms accompanied by fenestrated proximal ACA.
起源于大脑前动脉（ACA）近端开窗处的动脉瘤被认为是独特的。作者报告了一例59岁女性，因右侧ACA A1段开窗处破裂动脉瘤继发蛛网膜下腔出血（SAH）就诊。该患者还有一个未破裂的动脉瘤，位于右侧大脑中动脉分叉处。她的两个动脉瘤均通过手术夹闭成功治疗。从既往文献中，我们又发现了18例（1983 - 2011年）与ACA A1段开窗处相关的动脉瘤病例。所有病例均为囊状动脉瘤，79%的患者发生了SAH。根据相对于开窗段的解剖位置，ACA A1开窗处动脉瘤有三种亚型。最常见的类型是位于开窗动脉近端的动脉瘤（82%）。奇静脉ACA和发育不全的A1常伴有动脉瘤（分别为33%和31%），3例（16%）显示为多发动脉瘤。鉴于ACA A1开窗处容易发生动脉瘤且破裂风险高，早期处理可能对伴有ACA近端开窗处动脉瘤的患者有益。
