Relationship between syndrome elements and anterior communicating artery opening in patients with smptomatic severe carotid artery stenosis/occlusion

Objective To study the relationship between syndrome elements and anterior communicating artery(ACoA)opening in patients with symptomatic severe carotid artery stenosis/occlusion.Methods Thirty-six patients with symptomatic severe carotid stenosis/occlusion were collected,including 26 patients with cerebral infarction and 10 patients with transient ischemic attack(TIA).Syndrome elements at five time points were collected.Computer tomography angiography(CTA)combined with magenic resonance angiograp(MRA)was used to evaluate the primary collateral circulation,and the prognosis and syndrome elements were statistically analyzed according to whether the ACoA was open or not.Results The ACoA was open more in the primary collateral circulation among patients with symptomatic severe carotid stenosis/occlusion.There was a statistically significant difference in national institute of health stroke scale(NIHSS)score improvement and good prognosis[the modified rankin scale(mRS)≤2]between the ACoA open group and the ACoA nonopen group on the 90th day(P<0.05).The proportion of patients with internal wind syndrome,blood stasis syndrome,Qi deficiency syndrome,and Yin deficiency syndrome in the ACoA non-open group was higher than that in the open group.Conclusion In the patients with severe carotid artery stenosis/occlusion,the group with presence of anterior communicating artery had better prognosis.The syndrome elements are more complex in the group without the presence of anterior communicating artery.The proportion of Qi deficiency syndrome was positively correlated with the non-opening of anterior communicating artery.The imaging evaluation of collateral circulation can provide guidance for syndrome differentiation and treatment.

Endoscopic anatomical study on anterior communicating artery aneurysm surgery by endonasal transphenoidal approach

Background:Endonasal transphenoidal approach by neuroendoscopy has its own advantage,such as direct access invasive,better visualization of the anterior communicating artery aneurysm and so on.The study is to provide anatomical knowledge for anterior communicating artery aneurysm surgery by endonasal transphenoidal approach with neuroendoscopy.Materials:Take 10 skull base specimens,observe and measure the anatomical structures around anterior communicating artery.Take 10 cadaveric heads,simulate the anterior communicating artery aneurysm surgery with neuroendoscopy by endonasal transphenoidal approach.Find the natural opening of sphenoid sinus,then open the skull base,expand bone window in anterior skull base.After that,cut off the dura,find the optic nerve,optic chiasm,cisterna lamina terminalis,anterior cerebral artery,a portion of frontal lobe,anterior communicating artery complex and its important branches,such as heubner artery,hypothalamic artery,orbitofrontal artery and so on.Lift up anterior communicating artery complex and seperate arachnoid in cisterna lamina terminalis,the lamina terminalis is exposed.Block bilateral A1 of anterior cerebral artery with aneurysm clip,the anterior communicating artery complex and its important branches are in view,so we can clip anterior communicating artery aneurysm safely.Results:Anterior communicating artery aneurysm surgery can be finished with neuroendoscopy by endonasal transphenoidal approach.The vital structures can be clearly observed with neuroendoscopy.The rhombus anatomic region formed by bilateral olfactory nerve and optic nerve is a safe surgical area.According to the calculation,the safe surgical area is about 161.48 ± 12.78 mm2.Measure the distance between the important anatomic structures in the rhombus anatomic region.By means of SPSS 17 Statistical analysis softvvare,the measuring distance is expressed with (x ± S)mm.Conclusion:The anterior communicating aneurysm surgery by endonasal transphenoidal approach with neuroendoscopy has its own advantage,such as direct access,minimally invasive,less bleeding,light pain,quick recovery,better visualization of the anterior communicating artery aneurysm and so on.This operation approach needs further study and exploration to clinical application,in order to become a mature approach of anterior communicating artery aneurysm surgery.

Terson Syndrome:A Case of Anterior Communicating Artery Aneurysm Rupture with Spontaneous Subarachnoid Hemorrhage

Terson syndrome is manifested as retinal and vitreous hemorrhage with aneurysmal subarachnoid hemorrhage(SAH),and is associated with the severity,high mortality and poor prognosis of aneurysmal SAH.Severe Terson syndrome can lead to vision loss or even permanent blindness.The prevalence of Terson syndrome is 2.6%-50%on a global scale;however,it is often misdiagnosed due to the lack of routine ophthalmologic examination and the early comorbidities of cognitive disorder,laloplegia and coma.Herein,we report a 29-year-old male patient who suffered from aneurysmal SAH with Terson syndrome in department of neurosurgery,the First Affiliated Hospital,Zhejiang University,School of Medicine,to highlight the importance of early diagnosis and treatment of Terson syndrome.