Kim Young Rak, Lee Sung Ho, Bae Jin Woo, Choi Young Hoon, Ha Eun Jin, Kim Kang Min, Cho Won-Sang, Kang Hyun-Seung, Kim Jeong Eun
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Cerebrovasc Endovasc Neurosurg. 2023 Mar;25(1):62-68. doi: 10.7461/jcen.2022.E2022.01.003. Epub 2022 Aug 22.
The treatment of complicated anterior cerebral artery aneurysms remains challenging. Here, the authors describe a case of ruptured complicated A3 aneurysm, which was treated with trapping and in-situ bypass. A 47-year-old man presented to the emergency department with severe headache and vomiting. Computed tomography illustrated acute intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) confirmed a ruptured fusiform A3 aneurysm with lobulation and a daughter sac. Trapping of the ruptured fusiform A3 aneurysm and distal end-toside A4 anastomosis was performed. DSA on postoperative day 7 showed mild vasospasm to the afferent artery. However, 2 months later, DSA demonstrated that the antegrade flow through the anastomosis site had recovered. Thus, surgeons should be aware of the possibility of postsurgical vasospasm of anastomosed arteries, especially in cases of ruptured aneurysms.
复杂大脑前动脉动脉瘤的治疗仍然具有挑战性。在此，作者描述了一例破裂的复杂A3动脉瘤病例，该病例采用了动脉瘤夹闭和原位搭桥术进行治疗。一名47岁男性因严重头痛和呕吐就诊于急诊科。计算机断层扫描显示右额叶急性脑内出血。数字减影血管造影（DSA）证实为破裂的梭形A3动脉瘤，伴有分叶和子囊。对破裂的梭形A3动脉瘤进行夹闭，并进行远端A4端侧吻合。术后第7天的DSA显示传入动脉有轻度血管痉挛。然而，2个月后，DSA显示通过吻合部位的顺行血流已恢复。因此，外科医生应意识到吻合动脉术后血管痉挛的可能性，尤其是在动脉瘤破裂的情况下。
