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副A2段和基底动脉脑动脉瘤的显微手术：罕见病例报告及手术视频

Microsurgery for brain aneurysms in an accessory A2 and basilar arteries: a rare case presentation and surgical video.

作者信息

Bocanegra-Becerra Jhon E, Acha Sánchez José Luis, Contreras Montenegro Luis

机构信息

School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.

Vascular Neurosurgery and Skull Base Division, Department of Neurosurgery, Hospital Nacional Dos de Mayo, Lima, Peru.

出版信息

J Surg Case Rep. 2024 Jan 16;2024(1):rjad742. doi: 10.1093/jscr/rjad742. eCollection 2024 Jan.

DOI:10.1093/jscr/rjad742
PMID:38239374
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10795898/
Abstract

We present the case of a 58-year-old male with a 3-day history of sudden onset headache, loss of consciousness, and uncontrolled vomiting. The patient had 3/5 quadriparesis and a Glasgow coma scale (GCS) score of 8, which merited neurocritical intensive care. Brain imaging suggested the presence of two lesions: (i) a fusiform aneurysm of 12 × 7 mm in an accessory A2 artery of the anterior cerebral artery and (ii) an unruptured saccular aneurysm of 3.3 × 2.8 mm in the distal segment of the basilar artery. He was deemed a candidate for microsurgical management. Postoperatively, he had 4/5 quadriparesis, paresis of the right oculomotor nerve, and a GCS score of 13. A 3-month follow-up showed a significant improvement in neurological function with a score of 2 on the modified Rankin scale. The presented case illustrates the relevance of a nuanced acquaintance to operate in diseased anatomical variants and complex pathologies of narrow corridors.

摘要

我们报告了一例58岁男性患者，其突发头痛、意识丧失和无法控制的呕吐症状持续3天。患者存在四肢肌力3/5级及格拉斯哥昏迷量表（GCS）评分为8分的情况，因此需要进行神经重症监护。脑部影像学检查显示存在两个病变：（i）大脑前动脉A2段分支上一个12×7毫米的梭形动脉瘤，以及（ii）基底动脉远端一个3.3×2.8毫米的未破裂囊状动脉瘤。他被认为是显微外科治疗的候选对象。术后，他的四肢肌力为4/5级，右动眼神经麻痹，GCS评分为13分。3个月的随访显示神经功能有显著改善，改良Rankin量表评分为2分。本病例说明了在病变解剖变异和狭窄通道复杂病理情况下进行精细操作的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/35b6d5e2462c/rjad742f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/e65abd243625/rjad742f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/2cec44f81c32/rjad742f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/aa2c526a7be9/rjad742f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/35b6d5e2462c/rjad742f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/e65abd243625/rjad742f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/2cec44f81c32/rjad742f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/aa2c526a7be9/rjad742f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbe7/10795898/35b6d5e2462c/rjad742f4.jpg

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本文引用的文献

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Alternate Simultaneous Bilateral Carotid Angiography in Y-stent-Assisted Coil Embolization for an Anterior Communicating Artery Aneurysm with Triplicate A2 Variant.Y 型支架辅助弹簧圈栓塞治疗前交通动脉瘤伴三重 A2 变异时的交替同期双侧颈动脉造影
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Basilar apex aneurysm systematic review: Microsurgical versus endovascular treatment.基底动脉顶端动脉瘤系统评价：显微外科手术与血管内治疗的比较。
Neurochirurgie. 2022 Dec;68(6):661-673. doi: 10.1016/j.neuchi.2022.07.007. Epub 2022 Aug 11.
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Association of Anterior Communicating Artery Aneurysms with Triplicate A2 Segment of the Anterior Cerebral Artery.
前交通动脉瘤与大脑前动脉 A2 段三分叉的相关性。
World Neurosurg. 2020 Aug;140:e234-e239. doi: 10.1016/j.wneu.2020.05.005. Epub 2020 May 12.
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Expanding the Indications for Flow Diversion: Treatment of Posterior Circulation Aneurysms.扩大血流导向装置的适应证：后循环动脉瘤的治疗。
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Microsurgical clipping for anterior communicating artery aneurysm associated with the accessory anterior cerebral artery via the pterional approach.经翼点入路显微手术夹闭与大脑前动脉副支相关的前交通动脉瘤。
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Should we still consider clips for basilar apex aneurysms? A critical appraisal of the literature.我们是否仍应考虑使用夹子治疗基底动脉尖动脉瘤？对相关文献的批判性评价。
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