Monroy-Sosa Alejandro, Nathal Edgar, Rhoton Albert L
Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico; Neuroscience Functional Unit, National Cancer Institute, Mexico City, Mexico.
Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
World Neurosurg. 2017 Dec;108:519-528. doi: 10.1016/j.wneu.2017.09.032. Epub 2017 Sep 14.
BACKGROUND: Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, are present in 1.5%-9% of all intracranial aneurysms. Here we characterize the important microsurgical anatomy of DACAs; describe the surgical approach to treating these aneurysms with a minimally invasive surgical technique, the mini anterior interhemispheric approach (MAIA); and examine the nuances of aneurysm clipping in this region. METHODS: This was a retrospective and descriptive analysis of a series of aneurysm surgeries performed at the National Institute of Neurology and Neurosurgery in Mexico City. Cadaveric dissections were used to demonstrate relevant cerebrovascular anatomy. We analyzed patient demographic data and aneurysm characteristics. Patients' neurologic grade was evaluated using the Hunt and Kosnik (H-K) scale, and surgical outcomes were evaluated using the Glasgow Outcome Scale (GOS). Other variables were analyzed using the χ test. RESULTS: We analyzed a total of 32 DACA aneurysms (10 nonruptured and 22 ruptured), representing 5.8% of all aneurysms. The study cohort was 64.3% females and 35.7% males. H-K grade II was the most frequent classification (32.4%); 42.8% of patients presented with a Fisher grade IV aneurysm. Aneurysm location was classified as supra-genu, genu, or infra-genu. Eight patients had multiple aneurysms, among which 50% were located at the bifurcation of the middle cerebral artery. CONCLUSIONS: Surgical clipping through a MAIA approach is an excellent treatment option for pericallosal artery aneurysms.
背景:大脑前动脉远端动脉瘤(DACA),也称为胼周动脉动脉瘤,在所有颅内动脉瘤中占1.5%-9%。在此,我们描述DACA重要的显微外科解剖结构;描述采用微创外科技术——微型前纵裂入路(MAIA)治疗这些动脉瘤的手术方法;并探讨该区域动脉瘤夹闭的细微差别。 方法:这是一项对在墨西哥城国家神经病学和神经外科研究所进行的一系列动脉瘤手术的回顾性描述性分析。利用尸体解剖来展示相关的脑血管解剖结构。我们分析了患者的人口统计学数据和动脉瘤特征。采用Hunt和Kosnik(H-K)量表评估患者的神经功能分级,采用格拉斯哥预后量表(GOS)评估手术结果。使用χ检验分析其他变量。 结果:我们共分析了32例DACA动脉瘤(10例未破裂,22例破裂),占所有动脉瘤的5.8%。研究队列中女性占64.3%,男性占35.7%。H-KⅡ级是最常见的分级(32.4%);42.8%的患者表现为FisherⅣ级动脉瘤。动脉瘤位置分为膝上型、膝部型或膝下型。8例患者有多个动脉瘤,其中50%位于大脑中动脉分叉处。 结论:通过MAIA入路进行手术夹闭是治疗胼周动脉动脉瘤的极佳选择。
Acta Neurochir (Wien). 2013-9-18
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