Aso Kenta, Kashimura Hiroshi, Takeda Masaru, Chida Kohei
Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
Surg Neurol Int. 2015 Sep 28;6(Suppl 16):S418-20. doi: 10.4103/2152-7806.166178. eCollection 2015.
The common trunk of the fronto-orbital artery (FOA) and frontopolar artery (FPA) arising from the A1 segment of the anterior cerebral artery (ACA) associated with a ruptured aneurysm (AN), is rare.
The patient was a 52-year-old man who suffered from subarachnoid hemorrhage. Three-dimensional computed tomography angiography revealed an elongated and tortuous left A1 segment of the ACA and a saccular AN arising from the left A1 segment of the ACA at the origin of the cortical branch, defining its location just on the midline and behind the anterior communicating artery. This vessel had two branches. One branch ran along the inferior surface of the ipsilateral frontal lobe, and the other branch ran anteriorly and medially along the surface of the left hemisphere toward the frontal pole. The anomalous artery was interpreted as a common trunk of the FOA and FPA. Bifrontal craniotomy was performed. The anomalous artery arose from the A1 segment of the ACA at the origin of the AN, and the recurrent artery of Heubner branched off the anomalous artery. The AN was successfully obliterated, clipping with a bayonet-shaped Yasargil titanium clip. Complete AN occlusion and patency of both the A1 and the common trunk of the FOA and FPA, were confirmed intraoperatively by indocyanine green angiography.
Recognizing this variant preoperatively, could be helpful in preventing the complications of surgery.
大脑前动脉（ACA）A1段发出的额眶动脉（FOA）和额极动脉（FPA）的共同主干与破裂动脉瘤（AN）相关的情况较为罕见。
患者为一名52岁男性，患有蛛网膜下腔出血。三维计算机断层血管造影显示ACA的左A1段细长且迂曲，在皮质支起始处从ACA的左A1段发出一个囊状AN，确定其位置恰好在中线且在前交通动脉后方。该血管有两个分支。一个分支沿同侧额叶下表面走行，另一个分支沿左半球表面向前内侧走行至额极。这条异常动脉被解释为FOA和FPA的共同主干。实施了双额开颅手术。异常动脉在AN起始处从ACA的A1段发出，Heubner回返动脉从异常动脉发出。成功夹闭了AN，使用刺刀形Yasargil钛夹进行夹闭。术中通过吲哚菁绿血管造影证实AN完全闭塞以及A1段和FOA与FPA共同主干通畅。
术前识别这种变异可能有助于预防手术并发症。
