Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu Province, China.
World Neurosurg. 2020 Jan;133:21-24. doi: 10.1016/j.wneu.2019.09.052. Epub 2019 Sep 14.
Giant serpentine aneurysms that occur in the distal anterior cerebral artery are extremely rare and challenging to manage because of their complex structure. In this case, we show an aneurysm resection performed after in situ side-to-side A3-A3 bypass to treat a giant serpentine distal anterior cerebral artery aneurysm.
Here, we present the case of a 55-year-old man with a giant distal anterior cerebral artery serpentine aneurysm who presented with severe headache and progressive unconsciousness. Computed tomography and cerebral angiography revealed a giant serpentine aneurysm in the right A2 segment. Both the right pericallosal and callosal marginal arteries branched from the outflow tract. To relieve the mass effect and preserve distal blood flow, an in situ side-to-side A3-A3 anastomosis and a partial aneurysm resection were performed sequentially. Postoperative cerebral angiography revealed no aneurysm blood filling and good perfusion in both anterior cerebral artery territories.
Anterior cerebral artery giant serpentine aneurysms are rare and usually present with headache and mass effect. Aneurysm resection and distal flow protection are issues that we must consider. The sequential procedure of anastomosis and aneurysm resection is a feasible and safe option.
发生在大脑前动脉远端的巨大蛇形动脉瘤因其复杂的结构而极其罕见，且难以处理。在本例中，我们展示了在原位侧侧 A3-A3 旁路后进行的动脉瘤切除术，以治疗巨大的蛇形大脑前动脉远端动脉瘤。
我们在此介绍 1 例 55 岁男性患者，患有巨大的大脑前动脉远端蛇形动脉瘤，表现为严重头痛和进行性意识丧失。计算机断层扫描和脑血管造影显示右侧 A2 段有巨大的蛇形动脉瘤。右侧胼周动脉和胼缘动脉均发自流出道。为缓解占位效应并保留远端血流，我们依次进行了原位侧侧 A3-A3 吻合术和部分动脉瘤切除术。术后脑血管造影显示动脉瘤无血液充盈，大脑前动脉区域血供良好。
大脑前动脉巨大蛇形动脉瘤罕见，通常表现为头痛和占位效应。我们必须考虑动脉瘤切除术和远端血流保护的问题。吻合术和动脉瘤切除术的序贯程序是一种可行且安全的选择。
