Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan.
Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan.
World Neurosurg. 2024 Oct;190:278-283. doi: 10.1016/j.wneu.2024.07.145. Epub 2024 Jul 24.
Surgical treatment of large or giant thrombosed anterior cerebral artery (ACA) aneurysms often involves revascularization. Herein, we describe a unique and effective bypass technique to treat partially thrombosed giant distal ACA aneurysms in extremely narrow surgical corridors.
A 68-year-old man underwent aneurysm trapping and ACA revascularization for a partially thrombosed giant ACA aneurysm in a surgical corridor that was narrow due to anatomic factors. By combining a side-to-side anastomosis and an end-to-side anastomosis at a single anastomotic site, we successfully redirected blood flow from the left pericallosal artery to the right pericallosal and callosomarginal arteries.
Postoperatively, cerebral angiography showed that the blood flow in the aneurysm had disappeared, and the bypass remained open. The patient's functional disability gradually improved, and he reported consistently positive outcomes at the 6-month postoperative follow-up examination.
This revascularization technique may represent an effective novel treatment option, particularly when multiple revascularization procedures are required within a narrow surgical field.
大型或巨大血栓形成的大脑前动脉（ACA）动脉瘤的手术治疗通常需要进行血运重建。在此，我们描述了一种独特而有效的旁路技术，用于治疗在非常狭窄的手术通道中部分血栓形成的巨大远端 ACA 动脉瘤。
一名 68 岁男性因解剖因素导致手术通道狭窄而接受了部分血栓形成的巨大 ACA 动脉瘤的动脉瘤夹闭和 ACA 血运重建。通过在单个吻合部位进行侧侧吻合和端端吻合，我们成功地将血流从左大脑纵裂动脉重新引导至右大脑纵裂和胼周缘动脉。
术后脑血管造影显示动脉瘤内血流消失，旁路保持通畅。患者的功能障碍逐渐改善，在术后 6 个月的随访检查中报告持续积极的结果。
这种血运重建技术可能是一种有效的新治疗选择，特别是在狭窄的手术区域内需要多次血运重建时。
