Iwabuchi Naoya, Saito Atsushi, Fujimoto Kentaro, Nakamura Taigen, Sasaki Tatsuya
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Neurosurgery, Sendai Medical Center, Sendai, Japan.
Case Rep Neurol. 2018 Jun 22;10(2):140-149. doi: 10.1159/000488478. eCollection 2018 May-Aug.
Some cases of aneurysms originating from the fenestrated A1 segment of the anterior cerebral artery (ACA) have been reported, but the pitfalls of the surgical procedure have not been well determined. We herein report 2 cases of a saccular aneurysm arising from the fenestrated A1 segment. Case 1 was a 72-year-old man incidentally diagnosed with an unruptured left ACA aneurysm on magnetic resonance imaging (MRI). Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the left A1 segment. He underwent surgical clipping via the left pterional approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one small fenestrated trunk, preserving the other fenestrated trunk and perforators around the fenestration. Case 2 was a 73-year-old man incidentally diagnosed with an unruptured ACA aneurysm on MRI. Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the fenestrated left A1 segment. He underwent surgical clipping via the interhemispheric approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one hypoplastic fenestrated trunk, preserving the other fenestrated trunk and perforators around the aneurysm. Detailed intraoperative evaluations of the anatomical structure and hemodynamics around the fenestration are important. The intentional obliteration of a fenestrated trunk and application of fenestrated clips need to be considered in difficult cases in order to expose the aneurysmal neck.
已有关于起源于大脑前动脉（ACA）有窗A1段的动脉瘤病例报道，但该手术的陷阱尚未明确。我们在此报告2例起源于有窗A1段的囊状动脉瘤病例。病例1为一名72岁男性，在磁共振成像（MRI）检查中偶然发现未破裂的左侧ACA动脉瘤。脑血管造影显示一个囊状动脉瘤起源于左侧A1段近端。他通过左侧翼点入路接受了手术夹闭。动脉瘤起源于有窗左侧A1段近端分叉处。应用有窗环形夹闭塞动脉瘤颈部和一个小的有窗主干，保留另一个有窗主干及开窗周围的穿支。病例2为一名73岁男性，在MRI检查中偶然发现未破裂的ACA动脉瘤。脑血管造影显示一个囊状动脉瘤起源于有窗左侧A1段近端。他通过经纵裂入路接受了手术夹闭。动脉瘤起源于有窗左侧A1段近端分叉处。应用有窗环形夹闭塞动脉瘤颈部和一个发育不良的有窗主干，保留另一个有窗主干及动脉瘤周围的穿支。对开窗周围解剖结构和血流动力学进行详细的术中评估很重要。在困难病例中，为暴露动脉瘤颈部，需要考虑有意闭塞有窗主干并应用有窗夹。
