Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland;.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105578. doi: 10.1016/j.jstrokecerebrovasdis.2020.105578. Epub 2021 Jan 2.
Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case 1: 20-year-old patient with a traumatic, partially thrombosed 14 × 10 mm aneurysm of the right pericallosal artery (rPericA), distal to the origin of the right callosomarginal artery (rCMA). Complete trapping of the right dissection A3 aneurysm and flow replacement extra-to-intracranial (EC-IC) bypass (STA - radial artery - A4) was performed. Case 2: 16-year-old patient with a traumatic polylobulated, partially thrombosed 16 × 10 mm aneurysm of the rPericA. Microsurgical excision of the A3- segment harboring the aneurysm and flow replacement intra-to-intracranial (IC-IC) bypass via reimplantation of the right remaining PericA on the contralateral PericA (end-to-side anastomosis) was performed (in situ bypass). TICA of the dACA are exceptionally rare. Mechanical vessel wall injury and aneurysm formation of the dACA in blunt head trauma is very likely due to the proximity of the dACA with the rigid free edge of the falx. Given their nature as dissecting (complex) aneurysm, trapping and revascularization is a very important strategy. The interhemispheric cistern offers multiple revascularization options with its numerous donor vessels. The IC-IC bypass is often the simplest revascularization construct.
外伤性大脑前动脉远端动脉瘤（TICA）极为罕见，由于其血管解剖学特征，治疗颇具挑战。本研究旨在探讨外伤性大脑前动脉远端动脉瘤形成的机制，并结合两例病例，阐明此类患者的最佳治疗和再血管化策略。病例 1：患者为 20 岁男性，右侧胼周动脉（rPericA）远端存在创伤性、部分血栓形成的 14×10mm 动脉瘤，起源于右侧胼缘动脉（rCMA）。对右侧夹层 A3 动脉瘤进行完全夹闭，并实施了血流重建颅内外旁路（STA-桡动脉-A4）。病例 2：患者为 16 岁男性，右侧胼周动脉存在创伤性多叶状、部分血栓形成的 16×10mm 动脉瘤。对载瘤的 A3 段进行显微切除，并通过将右侧剩余胼周动脉重新植入对侧胼周动脉（端侧吻合）实施血流重建颅内网膜下旁路（原位旁路）。外伤性大脑前动脉远端动脉瘤极为罕见。在钝性头部创伤中，大脑前动脉远端由于紧邻镰状韧带的硬性游离缘，很可能发生机械性血管壁损伤和动脉瘤形成。鉴于其为夹层（复杂）动脉瘤的性质，夹闭和再血管化是非常重要的策略。大脑间裂拥有众多供血动脉，提供了多种再血管化选择。脑内血流重建通常是最简单的再血管化结构。
