Araki T, Ouchi M, Ikeda Y
Department of Neurosurgery, Kawachi General Hospital, Osaka, Japan.
No Shinkei Geka. 1996 Jan;24(1):87-91.
The incidence of intracranial dissecting aneurysms is lower than that of berry aneurysms. Following the recent spread of the use of cerebral angiography, however, the number of patients identified as having this type of aneurysm has been increasing. In a majority of cases of intracranial dissecting aneurysms, the aneurysm afflicted the vertebral and basilar arteries. After these, the internal carotid artery and the middle cerebral artery are the next most frequently affected. It is very rare that this type of aneurysm develops in the anterior cerebral artery. According to our search of the literature, only 17 cases of dissecting aneurysm of the anterior cerebral artery have been reported to date (including the case to be presented here). The case we recently encountered was that of a 52-year-old male. On October 25, 1994, the man suddenly developed a headache and strong paresis of the left leg while performing clerical work. The plain head CT, taken next day, revealed low density in the area supplied by the right anterior cerebral artery. An angiogram taken 6 days after onset disclosed characteristic signs of dissecting aneurysm (i.e., double lumen, etc.) at the A2 segment of the right anterior cerebral artery, as well as the presence of non-ruptured berry aneurysms at the bifurcation of the right middle cerebral artery. The non-ruptured berry aneurysms were treated by neck clipping, while the dissecting aneurysms were treated conservatively. The patient was discharged on March 21, 1995, without needing any assistance to walk. We analyzed the 17 reported cases of dissecting aneurysms of the anterior cerebral artery. The cause of this aneurysm was often hypertension, and only 3 of the 17 cases were rated as being idiopathic cases. The site of this aneurysm was often the pericallosal artery (segments A2, A3, etc.). Of the 17 patients, 11 were middle-aged or elderly (over 40). The male-to-female ratio was 13: 4, indicating a predominance of males. The incidence did not differ significantly between the right and left hemispheres. The number of ischemic cases was more than double that of hemorrhagic cases. Most ischemic cases had a good prognosis, even when treated conservatively. All 3 patients with the hemorrhagic type, who were treated conservatively, died.
颅内夹层动脉瘤的发病率低于浆果样动脉瘤。然而，随着近年来脑血管造影术使用的普及，被确诊患有此类动脉瘤的患者数量一直在增加。在大多数颅内夹层动脉瘤病例中，动脉瘤累及椎动脉和基底动脉。其次，颈内动脉和大脑中动脉是其次最常受累的部位。这种类型的动脉瘤在前脑动脉中发生非常罕见。根据我们对文献的检索，迄今为止，仅报道了17例前脑动脉夹层动脉瘤病例（包括此处要介绍的病例）。我们最近遇到的病例是一名52岁男性。1994年10月25日，该男子在从事文书工作时突然出现头痛和左腿严重无力。第二天进行的头部平扫CT显示右前脑动脉供血区域密度减低。发病6天后进行的血管造影显示右前脑动脉A2段有夹层动脉瘤的特征性征象（即双腔等），以及右大脑中动脉分叉处存在未破裂的浆果样动脉瘤。未破裂的浆果样动脉瘤通过夹闭瘤颈进行治疗，而夹层动脉瘤则采取保守治疗。患者于1995年3月21日出院，无需任何行走辅助。我们分析了17例已报道的前脑动脉夹层动脉瘤病例。这种动脉瘤的病因通常是高血压，17例中只有3例被评为特发性病例。这种动脉瘤的部位通常是胼周动脉（A2、A3等段）。17例患者中，11例为中年或老年（40岁以上）。男女比例为13:4，表明男性居多。左右半球的发病率无显著差异。缺血性病例的数量是出血性病例的两倍多。大多数缺血性病例即使采取保守治疗预后也良好。3例出血型患者均采取保守治疗，最终死亡。
