Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
Department of Neurosurgery, Cerebrovascular Center, Cheonan Chungmu Hospital, Cheonan, Chungcheongnam-do, Republic of Korea.
Neurol Sci. 2018 Oct;39(10):1735-1740. doi: 10.1007/s10072-018-3492-1. Epub 2018 Jul 10.
Proximal A1 segment aneurysms of the anterior cerebral artery (ACA) radiologically resemble internal carotid artery bifurcation (ICBIF) aneurysms because of their anatomical proximity. However, proximal A1 aneurysms exhibit distinguishing features, relative to ICBIF aneurysms. We report our experience of managing proximal A1 aneurysms, then compare them to ICBIF aneurysms.
Among 2191 aneurysms treated between 2000 and 2016 in a single institution, we retrospectively reviewed 100 cases categorized as ICBIF or A1 aneurysms. We included aneurysms originating from the ICBIF and ACA, proximal to the anterior communicating artery (A1 segment) and divided them into two groups: proximal A1 (n = 32) and ICBIF (n = 50). If any portion of the aneurysm involved the ICBIF, it was classified as ICBIF. Aneurysms wholly located in the A1 segment were classified as proximal A1. Patient factors and angiographic factors were evaluated and compared.
The proximal A1 group exhibited differences in aneurysm size (p = 0.013), posterior aneurysm direction (p = 0.001), and A1 perforators as incorporating vessels (p = 0.001). The proximal A1 group tended to rupture more frequently when the aneurysm was smaller (p = 0.046). One case of morbidity occurred in the proximal A1 group.
Compared to ICBIF aneurysms, proximal A1 aneurysms were smaller and directed posteriorly, with incorporating perforators. Because of these characteristics, it may be difficult to perform clipping with 360° view in microsurgical field. Therefore, when planning to treat proximal A1 aneurysms, different treatment strategies may be necessary, relative to those used for ICBIF aneurysms.
由于解剖位置相近，大脑前动脉（ACA）近端 A1 段动脉瘤在影像学上类似于颈内动脉分叉部（ICBIF）动脉瘤。然而，与 ICBIF 动脉瘤相比，近端 A1 动脉瘤具有一些独特的特征。我们报告了我们处理近端 A1 动脉瘤的经验，并将其与 ICBIF 动脉瘤进行比较。
在一家医疗机构 2000 年至 2016 年间治疗的 2191 个动脉瘤中，我们回顾性分析了 100 个被归类为 ICBIF 或 A1 动脉瘤的病例。我们纳入了起源于 ICBIF 和 ACA、位于前交通动脉（A1 段）近端的动脉瘤，并将其分为两组：近端 A1（n=32）和 ICBIF（n=50）。如果动脉瘤的任何部分涉及 ICBIF，则将其归类为 ICBIF。完全位于 A1 段的动脉瘤被归类为近端 A1。评估并比较了患者因素和血管造影因素。
在动脉瘤大小（p=0.013）、后向动脉瘤方向（p=0.001）和 A1 穿支血管作为包含血管（p=0.001）方面，近端 A1 组存在差异。当动脉瘤较小时，近端 A1 组更倾向于破裂（p=0.046）。近端 A1 组发生 1 例并发症。
与 ICBIF 动脉瘤相比，近端 A1 动脉瘤较小且向后生长，伴穿支血管。由于这些特征，在显微镜下手术视野中可能难以实现 360° 夹闭。因此，在计划治疗近端 A1 动脉瘤时，相对于治疗 ICBIF 动脉瘤，可能需要采用不同的治疗策略。
