Ding Xinmin, Nisson Peyton L, James Whitney S, Lawton Michael T, Ren Shaohua, Jia Lu, Ji Honging
ShanXi Province People's Hospital, Yinze District, Taiyuan, China; Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.
University of Arizona College of Medicine, Tucson, Arizona, USA.
World Neurosurg. 2017 Aug;104:291-302. doi: 10.1016/j.wneu.2017.04.106. Epub 2017 Apr 26.
This study aims to establish a new classification system for proximal anterior cerebral artery (A1) aneurysms and to offer treatment strategies, based on the lessons learned by studying the case reports of 41 patients with A1 aneurysms.
A total of 2332 consecutive patients with intracranial aneurysms were treated at a single medical center between June 2005 and May 2015. Forty-one patients with 42 A1 aneurysms were treated by surgical clipping or endovascular coiling. Clinical data, radiographic results, treatments, and patient outcomes were later collected and analyzed.
Of 2332 intracranial aneurysm patients, 1.76% (n = 41) had a total of 42 A1 aneurysms. Twenty-six of these (62%) were proximal A1 segment aneurysms, 9 (21%) were distal A1 segment aneurysms, and 7 (17%) were fusiform A1 aneurysms. A1 aneurysms can be classified into 3 main types. Types IA and IB originate from the posterior wall of the proximal A1 segment. Type IA projects posterior-inferiorly, whereas type IB projects posterior-superiorly. Type IIA originates from the distal trunk of the A1 artery. Type IIB originates from an angle of an abnormal cortical branch or a ring of an A1 arterial fenestration. Type III consists of fusiform or dissecting aneurysms located anywhere along the A1 segment. After studying the range of treatments and outcomes, when treating these complex morphologies, we recommend clipping type I and II A1 aneurysms and embolizing type III A1 aneurysms.
A1 artery aneurysms are a rare type of aneurysm with unique characteristics. The classification system proposed here accurately summarizes these characteristics to better guide treatment strategies.
本研究旨在建立一种新的大脑前动脉近端（A1）动脉瘤分类系统，并根据对41例A1动脉瘤病例报告的研究经验提供治疗策略。
2005年6月至2015年5月期间，在一家医疗中心连续治疗了2332例颅内动脉瘤患者。41例患者共42个A1动脉瘤接受了手术夹闭或血管内栓塞治疗。随后收集并分析了临床数据、影像学结果、治疗方法和患者预后。
在2332例颅内动脉瘤患者中，1.76%（n = 41）共有42个A1动脉瘤。其中26个（62%）为A1段近端动脉瘤，9个（21%）为A1段远端动脉瘤，7个（17%）为梭形A1动脉瘤。A1动脉瘤可分为3种主要类型。IA型和IB型起源于A1段近端后壁。IA型向后下突出，而IB型向后上突出。IIA型起源于A1动脉远端主干。IIB型起源于异常皮质分支的夹角或A1动脉开窗环。III型由沿A1段任何部位的梭形或夹层动脉瘤组成。在研究了治疗范围和结果后，对于这些复杂形态的动脉瘤，我们建议夹闭I型和II型A1动脉瘤，栓塞III型A1动脉瘤。
A1动脉动脉瘤是一种罕见的具有独特特征的动脉瘤。本文提出的分类系统准确地总结了这些特征，以更好地指导治疗策略。
