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.

Morphological predictors of posterior communicating artery aneurysms rupture

Objective: The conflicting findings of previous morphological studies on intracranial aneurysm rupture may be caused by the different locations of aneurysms. We aimed to determine the independent risk factors of aneurysm rupture by focusing on only posterior communicating artery(Pcom A) aneurysms. Methods: In 89 PcomA aneurysms(58 ruptured, 31 unruptured), clinical and morphological characteristics were compared between the ruptured and unruptured groups. Multivariate logistic regression analysis was performed to determine the independent predictors for the rupture status of PcomA aneurysms. Results: In univariate analyses, the aneurysm dome size, aspect ratio, size ratio,dome‐to‐neck ratio, and inflow angle were significant parameters. With multivariate analyses, only the aneurysm dome size and inflow angle were significantly associated with the rupture status of PcomA aneurysms. Conclusions: Morphology was related with rupture of PcomA aneurysms. The aneurysm dome size and inflow angle were found to be the independent parameters characterizing the rupture status of PcomA aneurysms.

Intentional Compartmentalized Embolization of Wide-neck Aneurysms Incorporating the Posterior Communicating Artery to Preserve Flow

Background:Endovascular coiling for wide-neck aneurysms with a branch arising from the aneurysmal sac is challenging and sometimes considered impossible.This study aims to present our experience in treating wide-neck internal carotid artery(ICA)aneurysms with a posterior communicating artery(PComA)arising from the sac using a strategy of stenting the ICA and intentional compartmentalization to preserve the flow in the PComA.Methods:Eight consecutive cases of wide-neck ICA aneurysms with a fetal-type PComA arising from the aneurysmal sac were embolized from January 2015 to June 2018 at the First Affiliated Hospital,College of Medicine,Zhejiang University.Demographics,angiographic technique,procedural complications and clinical outcomes were reviewed.Results:There were 2 men and 6 women ranging from 56 to 81 years of age.Of the 8 cases,3 were ruptured and 5 were unruptured aneurysms.Stents were successfully deployed in all 8 cases.Near-complete occlusion was achieved in 3 cases(37.5%),neck remnant in 4(50%)and sac remnant in one(12.5%)of the cases.One case suffered transient ischemic attack after procedure completion.The clinical outcome was favorable in all 8 cases(modified Rankin scale 0-1).No rebleeding occurred during clinical follow-up.Conclusion:Stent-assisted compartmentalized embolization is feasible and safe in the treatment of wide-neck ICA aneurysm with a PComA arising from the sac.

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.

Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm

AIM:To explore the risk factors of oculomotor nerve palsy(ONP)in patients with intracranial aneurysm(IA)and develop a nomogram model for predicting ONP of IA patients.METHODS:A total of 329 IA patients were included.Logistic regression analysis was applied to identify independent factors,which were then integrated into the nomogram model.The performance of the nomogram model was evaluated by calibration cur ve,receiver operating curve(ROC),and decision curve analysis.RESULTS:Univariate and multivariate logistic regression analysis indicated posterior communicating artery(PCo A)aneur ysm[hazard ratio(HR)=17.13,P<0.001]and aneurysm diameter(HR=1.31,P<0.001)were independent risk factors of ONP in IA patients.Based on the results of logistic regression analysis,a nomogram model for predicting the ONP in IA patients was constructed.The calibration curve indicated the nomogram had a good agreement between the predictions and observations.The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve(AUC)of 0.863.The decision curve analysis showed that the nomogram was powerful in the clinical decision.PCo A aneurysm(HR=3.38,P=0.015)was identified to be the only independent risk factor for ONP severity.CONCLUSION:PCo A aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients.The nomogram established is performed reliably and accurately for predicting ONP.PCo A aneurysm is the only independent risk factor for ONP severity.

Remnants of embryonic arteries on the brain base:A case report

The posterior communicating artery (PCoA) arises from the cerebral part of the internal carotid artery and reaching the interpeduncular cistern unites with the posterior cerebral artery, marking the beginning of its post-communicating part. We accidentally found a case of an unusual origin and termination of the right PCoA associated with a presence of the right olfactory artery remnant in a 35-year-old male cadaver routinely dis-sected at Institute of Forensic Medicine. Presented vascular variations have not been reported previously in the literature. In the event of PCoA origin from the right middle cerebral artery normally developed from the cra-nial end of primitive internal carotid artery, as well as the PCoA junction with basilar tip, this PCoA could be the most cranial carotid-basilar anastomosis. Simultaneously, here presented right olfactory artery remnant could be the third variant of this persistent embryonic artery.