Ghogawala Z, Shumacher J M, Ogilvy C S
Department of Cerebrovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Neurosurgery. 1996 Aug;39(2):393-6. doi: 10.1097/00006123-199608000-00034.
Distal basilar artery aneurysms represent 5 to 8% of intracranial aneurysms. It is crucial to preserve all of the basilar apex perforating vessels when dissecting in this region. This report is the first to describe a rostral basilar perforating artery that was the anatomic origin of a cerebral aneurysm.
A 56-year-old woman presenting with subarachnoid hemorrhage underwent initial four-vessel cerebral angiography that did not demonstrate the source of her hemorrhage. A follow-up cerebral angio-gram 9 days later suggested a small aneurysm in the region of the left superior cerebellar artery.
A left pterional craniotomy was performed. An aneurysm arising from the origin of a distal basilar perforating artery was identified and obliterated with a small vascular clip. Flow was preserved in the perforating vessel, and the patient had an excellent outcome.
The findings in the report illustrate the novel anatomic principle that a distal basilar perforating vessel can serve as the anatomic origin of a cerebral aneurysm. Knowledge of this entity would be helpful in avoiding complications at surgery, including perforator injury or aneurysmal rupture in such cases.
基底动脉远端动脉瘤占颅内动脉瘤的5%至8%。在此区域进行解剖时，保留所有基底动脉尖穿支血管至关重要。本报告首次描述了一条脑桥基底穿支动脉是脑动脉瘤的解剖学起源。
一名56岁蛛网膜下腔出血女性患者最初接受了四血管脑血管造影，未显示出血源。9天后的随访脑血管造影提示左侧小脑上动脉区域有一个小动脉瘤。
实施了左侧翼点开颅术。发现一个起源于基底动脉远端穿支动脉起始处的动脉瘤，并用一个小血管夹将其夹闭。穿支血管血流得以保留，患者预后良好。
本报告中的发现阐明了一个新的解剖学原理，即基底动脉远端穿支血管可作为脑动脉瘤的解剖学起源。了解这一实体有助于避免手术并发症，包括此类病例中的穿支损伤或动脉瘤破裂。
