Chen Junhui, Li Mingchang, Zhu Xun, Chen Yan, Zhang Chunlei, Shi Wenwen, Chen Qianxue, Wang Yuhai
Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China.
Front Neurol. 2020 Sep 8;11:1020. doi: 10.3389/fneur.2020.01020. eCollection 2020.
Anterior communicating artery aneurysms account for 23-40% of ruptured intracranial aneurysms and 12-15% of unruptured aneurysms and are the most common intracranial ruptured or unruptured aneurysms. Because they have relatively complex anatomical structures and anatomical variations and are adjacent to important blood vessels and structures, in the process of microsurgical exposure of an Anterior communicating artery aneurysm, attention should be paid not only to the anatomical characteristics of the aneurysm itself but also to the adjacent important blood vessels and perforating arteries; therefore, both surgical clipping and endovascular embolization are serious challenges for neurosurgeons. No matter which treatment is chosen, it is necessary to determine the structure of the Anterior communicating artery and its perforating arteries as well as whether there is a fenestration deformity of the Anterior communicating artery and the relationship between bilateral A1-A2 before surgery. The shape and size of the aneurysm itself and its location relative to adjacent blood vessels also need to be considered to better complete the procedure, and this is especially true for microsurgical clipping. Clarifying the anatomy before surgery is helpful for better selecting the surgical approach and surgical side, which could affect the intraoperative exposure of the aneurysm and adjacent arteries, the surgical difficulty, the resection rate, and the postoperative complications. Therefore, starting with Anterior communicating artery aneurysms and their adjacent structures and variations, this paper reviews the latest progress in surgical treatment based on anatomic specificity as well as the most recent clinical studies.
前交通动脉瘤占颅内破裂动脉瘤的23% - 40%，未破裂动脉瘤的12% - 15%，是颅内最常见的破裂或未破裂动脉瘤。由于其解剖结构和解剖变异相对复杂，且毗邻重要血管和结构，在前交通动脉瘤显微手术显露过程中，不仅要关注动脉瘤本身的解剖特点，还要关注相邻的重要血管和穿动脉；因此，手术夹闭和血管内栓塞对神经外科医生来说都是严峻的挑战。无论选择哪种治疗方法，术前都有必要明确前交通动脉及其穿动脉的结构、前交通动脉是否存在开窗畸形以及双侧A1 - A2之间的关系。还需要考虑动脉瘤本身的形状、大小及其相对于相邻血管的位置，以便更好地完成手术操作，显微手术夹闭尤其如此。术前明确解剖结构有助于更好地选择手术入路和手术侧，这可能会影响动脉瘤及相邻动脉的术中显露、手术难度、切除率和术后并发症。因此，本文从前交通动脉瘤及其相邻结构和变异入手，综述基于解剖特异性的手术治疗最新进展以及最新的临床研究。
