Dumitrescu Ana Maria, Chiran Dragos Andrei, Stan Cristinel Ionel, Paraschiv Cringuta Mariana, Dobrin Nicolaie, Chiriac Alexandru, Leon Maria Magdalena, Dima-Cozma Lucia Corina, Dascalu Cristina Gena, Radulescu Ana Marina, Gavril Roxana Florentina, Sava Anca
Department of Morpho-Functional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
Department of Medical Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
NeuroSci. 2025 Aug 18;6(3):81. doi: 10.3390/neurosci6030081.
The literature shows that anterior communicating artery (AcoA) aneurysms are the most common intracranial aneurysms. To date, there has only been one postmortem study focused on the correlations between autopsy findings and imaging results in cases of intracranial aneurysms associated with anatomical variants of the circle of Willis (CW).
We investigated the anatomical variants of the CW associated with the occurrence and rupture of AcoA aneurysms by performing comparative analyses, in the same patients, of postmortem autopsy data with antemortem computed tomography-angiography (CTA) results obtained in the first 48 h after the onset of subarachnoid hemorrhage. Our retrospective observational study identified the anatomical variants of the CW at autopsy in 16 deceased adult Romanian patients with AcoA aneurysms over a 12-year period (2010-2022).
The autopsy findings revealed that the AcoA ruptured aneurysms had a mean external diameter of 9.50 mm, and 71.4% of them presented three or four anatomical variants inside the same CW. The initial antemortem CTA examination correctly located the AcoA aneurysms in all cases (100%), and an anatomical variant of the CW was only noted in 18.75% of patients. The final postmortem re-analyzed the same CTA images identified in all cases (100%), focusing on both the AcoA aneurysm and all anatomical variants of the CW found during the autopsies.
Although it was previously thought that the occurrence of AcoA aneurysms is related only to the hemodynamic changes induced by the nearby arterial anatomical variants, we identified the simultaneous involvement of at least one hypoplastic artery and one or two PCA fetal-type anatomical variants that were located in both the anterior and posterior parts of the CW. Furthermore, if sufficient time is devoted to the CT-angiography analysis and interpretation of the images, anatomical variants of the circle of Willis associated with AcoA aneurysms can be identified as accurately as they are in invasive postmortem autopsy examinations.
文献表明，前交通动脉（AcoA）动脉瘤是最常见的颅内动脉瘤。迄今为止，仅有一项尸检研究聚焦于颅内动脉瘤合并 Willis 环（CW）解剖变异病例的尸检结果与影像学结果之间的相关性。
我们通过对同一患者蛛网膜下腔出血发病后 48 小时内获得的生前计算机断层血管造影（CTA）结果与死后尸检数据进行比较分析，研究了与 AcoA 动脉瘤发生和破裂相关的 CW 解剖变异。我们的回顾性观察研究在 12 年期间（2010 - 2022 年）对 16 例已故成年罗马尼亚 AcoA 动脉瘤患者进行了尸检，确定了 CW 的解剖变异。
尸检结果显示，破裂的 AcoA 动脉瘤平均外径为 9.50 毫米，其中 71.4%在同一 CW 内呈现出三种或四种解剖变异。最初的生前 CTA 检查在所有病例中（100%）都正确定位了 AcoA 动脉瘤，仅 18.75%的患者发现了 CW 的解剖变异。最终的死后重新分析在所有病例中（100%）都识别出了相同的 CTA 图像，重点关注 AcoA 动脉瘤以及尸检过程中发现的 CW 的所有解剖变异。
尽管之前认为 AcoA 动脉瘤的发生仅与附近动脉解剖变异引起的血流动力学变化有关，但我们发现至少一条发育不全的动脉以及位于 CW 前部和后部的一到两个胎儿型 PCA 解剖变异同时受累。此外，如果有足够的时间进行 CT 血管造影图像分析和解读，与 AcoA 动脉瘤相关的 Willis 环解剖变异能够像侵入性尸检一样准确识别。
