CTA及DSA容易漏诊的微小前交通动脉瘤手术

Surgery for small aneurysms of anterior communicating artery easily missed by CTA and DSA

目的探讨微小前交通动脉瘤被局部血管干扰、漏诊的原因。方法回顾性分析7例术前CTA及DSA难以诊断的前交通微小动脉瘤病人的临床资料,均行手术开颅探查,根据手术中具体情况,结合前交通动脉解剖特点,分析影像学漏诊的原因。结果 3例术前CTA载瘤动脉"成角凸起"类似正常血管折角,术中证实是微小动脉瘤;3例术前无法判断是动脉瘤还是分支血管,手术证实微小动脉瘤周围存在血管变异、成窗畸形等;1例误判后交通动脉瘤破裂出血,术中发现责任动脉瘤为术前造影未发现的微小前交通动脉瘤。7例均成功手术夹闭。术后随访6~24个月,出现脑积水2例,记忆力下降2例,精神障碍1例;GOS评分均≥4分。结论微小前交通动脉瘤体积小,造影剂难以充盈,分支成窗变异互相遮挡容易漏诊。

Objective To explore the reasons that very small anterior communicating artery aneurysm is easily interfered by local blood vessels and misdiagnosed.Methods Clinical data of 7 patients with anterior communicating artery aneurysm difficult to be diagnosed by CTA and DSA were analyzed retrospectively.All the patients underwent craniotomy and exploration,and the reasons for imaging missed diagnosis were analyzed according to the specific conditions during surgery and anatomical characteristics of anterior communicating artery.Results Before the operation,the CTA showed bearing arteries of 3 patients were"angulated and raised"similar to the normal vessel angle,which was proved to be microarterial aneurysm during the operation.Three patients could be not judged of whether these angle-like protrusions were aneurysms or branches of blood vessels before operation,then,the vascular variation and window forming deformity around the microaneurysms were confirmed by operation.One patient was misdiagnosed with the rupture and hemorrhage of posterior communicating aneurysm,and the responsible aneurysm was found to be a small anterior communicating aneurysm undiscovered by preoperative angiography.All the 7 patients were successfully clipped.During a follow-up period of 6 to 24 months,hydrocephalus occurred in 2 patients,memory declined in 2 and mental disorder in 1,GOS scores all were greater than or equal to 4 points.Conclusion Small anterior communicating aneurysms are too small to fill with contrast agent,and easy to be misdiagnosed due to branching and window malformation.