Hosoda K, Fujita S, Kawaguchi T, Shose Y, Hamano S
Department of Neurosurgery, Hyogo Brain and Heart Center, Himeji, Japan.
Neurosurgery. 1995 Mar;36(3):441-6. doi: 10.1227/00006123-199503000-00001.
We report A series of 20 consecutive patients with 21 saccular aneurysms of the proximal (M1) segment of the middle cerebral artery. The incidence of M1 aneurysms was 3.0% among 660 patients with intracranial aneurysms and 12.9% among 155 patients with middle cerebral artery aneurysms in our center. Of the 20 patients, 2 were men and 18 were women. The aneurysms were classified into two types: the superior wall type (9 cases), arising at the origin of the lenticulostriate or fronto-orbital artery, and the inferior wall type (12 cases), arising at the origin of the early temporal branches. Twelve (60%) patients had ruptured M1 aneurysms. The incidence of multiple aneurysms was high (nine patients, 45%), and M1 aneurysms were responsible for subarachnoid hemorrhage in four patients. Of 14 M1 aneurysms greater than 5 mm in diameter, 11 (78.6%) ruptured. In contrast, only one (14.3%) of seven small (< or = 5 mm) aneurysms ruptured. In 12 patients with ruptured M1 aneurysms, intracerebral hematomas were recognized in 6 (50%). Intracerebral hematomas by the superior wall M1 aneurysms were located in the frontal lobe, and those by the inferior wall M1 aneurysms were in the temporal lobe. Fifteen patients (75%) made a useful recovery 6 months after surgery. Four patients (20%), who were in poor grade condition preoperatively, remained severely disabled. One patient died of sepsis 2 months after she recovered well from the operation. Special attention to the lenticulostriate arteries to avoid injury is critical for successful surgical treatment.
我们报告了连续20例患有21个大脑中动脉近端（M1）段囊状动脉瘤的患者。在我们中心，颅内动脉瘤患者中M1动脉瘤的发生率为3.0%，大脑中动脉动脉瘤患者中为12.9%。20例患者中，男性2例，女性18例。动脉瘤分为两种类型：上壁型（9例），起源于豆纹动脉或额眶动脉起始处；下壁型（12例），起源于早期颞支起始处。12例（60%）患者的M1动脉瘤破裂。多发动脉瘤的发生率较高（9例，45%），4例患者的蛛网膜下腔出血由M1动脉瘤所致。直径大于5 mm的14个M1动脉瘤中，11个（78.6%）破裂。相比之下，7个小动脉瘤（直径≤5 mm）中只有1个（14.3%）破裂。12例M1动脉瘤破裂的患者中，6例（50%）出现脑内血肿。上壁M1动脉瘤所致脑内血肿位于额叶，下壁M1动脉瘤所致脑内血肿位于颞叶。15例患者（75%）术后6个月恢复良好。4例患者（20%）术前病情较差，仍严重残疾。1例患者术后恢复良好，但2个月后死于败血症。手术成功治疗的关键是特别注意豆纹动脉以避免损伤。
