Inci S, Erbengi A, Ozgen T
Hacettepe University, Medical School, Department of Neurosurgery, Ankara, Turkey.
Surg Neurol. 1998 Aug;50(2):130-9; discussion 139-40. doi: 10.1016/s0090-3019(97)00344-3.
Distal anterior cerebral artery aneurysms are rare and compose about 4.5% of all intracranial aneurysms. They generally arise at the bifurcation of the pericallosal and callosomarginal arteries. Their surgical approach is different from those of other anterior circulation aneurysms. These aneurysms present some special difficulties for neurosurgeons, including narrow exposure in the interhemispheric fissure, dense adhesions between the cingulate gyri, difficulty in controlling the parent artery, and the association of multiple aneurysms and vascular anomalies.
Between January 1975 and May 1996, 14 cases of saccular aneurysms of the distal anterior cerebral artery were operated at the University of Hacettepe. The clinical presentations, neuroradiological findings, and operative approaches of these aneurysms were analyzed. In addition, the clinical series and isolated case reports in the English literature were also extensively reviewed.
The incidence of the aneurysms in this location was 2.8% of a total of 494 surgically treated cases in our center. Of 14 patients, eight were women and six were men. Multiple aneurysms were found in five patients (35%). All patients were operated via the interhemispheric route. Thirteen patients had good outcome and one patient died.
We believe that all difficulties related to distal anterior cerebral artery aneurysms can be minimized with sufficient knowledge of microsurgery and surgical anatomy, using microtechniques and experience.
大脑前动脉远端动脉瘤较为罕见，约占所有颅内动脉瘤的4.5%。它们通常起源于胼周动脉和胼缘动脉的分叉处。其手术入路与其他前循环动脉瘤不同。这些动脉瘤给神经外科医生带来了一些特殊困难，包括半球间裂暴露狭窄、扣带回之间粘连紧密、控制载瘤动脉困难以及合并多发动脉瘤和血管异常。
1975年1月至1996年5月，在哈杰泰佩大学对14例大脑前动脉远端囊状动脉瘤进行了手术。分析了这些动脉瘤的临床表现、神经放射学表现和手术入路。此外，还广泛回顾了英文文献中的临床系列报道和个案报告。
在我们中心，该部位动脉瘤的发生率占494例手术治疗病例的2.8%。14例患者中，8例为女性，6例为男性。5例患者（35%）发现有多发动脉瘤。所有患者均通过半球间入路进行手术。13例患者预后良好，1例死亡。
我们认为，通过充分掌握显微外科技术和手术解剖知识，运用显微技术和经验，可以将与大脑前动脉远端动脉瘤相关的所有困难降至最低。
