上突型宽颈前交通动脉瘤的分型和手术夹闭策略

Classification and clipping strategy of superior projecting anterior communicating artery aneurysms

目的探讨上突型宽颈前交通动脉瘤的分型和手术夹闭策略。方法回顾性分析经手术治疗的前交通动脉瘤患者的影像学及手术资料。根据术中显微解剖时双侧A2构成的虚拟平面与瘤体位置,划分上突型前交通动脉瘤的分型。结果上突型前交通动脉瘤分为4型:Ⅰ型,动脉瘤体位于双侧A2前方,使用直夹夹闭;Ⅱ型,动脉瘤体位于双侧A2之间,使用直开窗夹夹闭;Ⅲ型,动脉瘤体位于双侧A2后方,使用直开窗夹夹闭;Ⅳ型又分为Ⅳa型(A2平面开放型)和Ⅳb型(A2平面闭合型)。Ⅳa型同侧A2位于瘤体后方,对侧A2位于瘤体前方,使用直夹夹闭;Ⅳb型同侧A2位于瘤体前方,对侧A2位于瘤体后方,使用直开窗夹夹闭。结论本分型系统和夹闭策略有助于制定详尽的手术计划,减少手术并发症率和瘤颈残留率。使用直开窗夹和串联夹闭技术仍是上突型前交通动脉瘤夹闭治疗的重要手段。

Objective To explore classification system and clipping strategy of superior projecting anterior communicating artery（AComA） aneurysms.Methods Our classification is based on the virtual two-dimensional plane created by both proximal A2 segments and its relationship with the dome of aneurysm.Results We classify superior projecting AComA aneurysms into four categories-type I,Ⅱ,Ⅲ,and Ⅳ.Type I is defined by dome projected anteriorly to the virtual plane.Type Ⅱ is defined by bisection of the dome by this plane.Type Ⅲ is defined by dome projected posteriorly to this plane.Type Ⅳ is divided into Ⅳa （an open A2 plane） and Ⅳb （a closed A2 plane）.Straight clips are used type I and Ⅳa,whereas fenestrated clips are used frequently in type Ⅱ,Ⅲ,and Ⅳb.Conclusions Our classification system for superiorly projected AComA aneurysms is an adjunct to preoperative planning,which may decrease complications and recurrence.Fenestrated clips and tandem clipping techniques are mandatory for microsurgical treatments of superiorly projected AComA aneurysms.