BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphol...BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall,which is an independent risk factor for rupture and hemorrhage.Lobular aneurysms located in the anterior communicating artery complex account for 36.9%of all intracranial lobular aneurysms.Due to its special anatomical structure,both craniotomy and endovascular treatment are more difficult.Compared with single-capsule aneurysms,craniotomy for lobular intracranial aneurysms has a higher risk and complication rate.AIM To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm(ACoAA).METHODS Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included.Their demographic,clinical and imaging characteristics,endovascular treatment methods and follow-up results were collected.RESULTS A total of 24 patients with ruptured lobulated ACoAA were included,including 9 males(37.5%)and 15 females(62.5%).Their age was 56.2±8.9 years old(range 39-74).The time from rupture to endovascular treatment was 10.9±12.5 h.The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width were 3.0±0.7 mm.Nineteen patients(79.2%)were double-lobed and 5(20.8%)were multilobed.Fisher's grade:Grade 2 in 16 cases(66.7%),grade 3 in 6 cases(25%),and grade 4 in 2 cases(8.3%).Hunt-Hess grade:Grade 0-2 in 5 cases(20.8%),grade 3-5 in 19 cases(79.2%).Glasgow Coma Scale score:9-12 in 14 cases(58.3%),13-15 in 10 cases(41.7%).Immediately postprocedural Raymond-Roy grade:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Raymond-Roy grade in imaging follow-up for 2 wk to 3 months:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Followup for 2 to 12 months showed that 21 patients(87.5%)had good functional outcomes(modified Rankin Scale score≤2),and there were no deaths.CONCLUSION Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.展开更多
Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm (DACAA) patients treated over the last 3 years. Methods 9 consecutive cases of ruptured DACAA...Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm (DACAA) patients treated over the last 3 years. Methods 9 consecutive cases of ruptured DACAA operated from October 2007 to March 2010 were reviewed and followed up. Results 11 aneurysms were clipped展开更多
BACKGROUND： Hemodynamic changes accompany the initiation, development and rupture of middle cerebral artery （MCA） aneurysms. The complexity of the intraaneurysmal hemodynamic factors has not been completely clarifi...BACKGROUND： Hemodynamic changes accompany the initiation, development and rupture of middle cerebral artery （MCA） aneurysms. The complexity of the intraaneurysmal hemodynamic factors has not been completely clarified by the indirect measures and methods used in previous studies. OBJECTIVE： To evaluate correlations of intraoperative hemodynamic factors to initiation and rupture of MCA aneurysms. DESIGN, TIME AND SETTING： A case-control study was performed at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China between March and October 2008. PARTICIPANTS： A total of 12 consecutive patients diagnosed with MCA aneurysms （MCA aneurysms group） and five patients without middle cerebral artery aneurysms （with aneurysms located at other arteries, control group） were enrolled at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China. METHODS： The proximal and distal arteries of MCA aneurysms were exposed visibly in the MCA aneurysm group. The M1 segment of MCA without the aneurysm and the aneurysm on other arteries were also exposed visibly in the control group. Hemodynamic indices were then measured using an intraoperative 16 MHz probe installed in a Multi-Dop TCD8X4 device. MAIN OUTCOME MEASURES： Mean （time-averaged velocity） difference, maximum mean, pulsatility index difference, maximum pulsatility index, resistance index difference, maximum resistance index; correlation of development and rupture of MCA aneurysms to intraoperative hemodynamic factors of the parent artery. RESULTS： A total of 12 patients underwent microsurgery for treatment to occlude 15 MCA aneurysms. Of the 15 MCA aneurysms, 12 were located at the bifurcation, two at the M1 segment and one at the M3 segment; eight of the aneurysms were unruptured and seven were ruptured. The whole indices with combination mean difference, maximum mean, and maximum pulsatility index of the aneurysms were important factors influencing the rupture of MCA aneurysms （t = 2.92, P = 0.03, constant）. A higher velocity intraaneurismal flow at the bifurcation was identified （t = 3.48, P = 0.01, constant）. After the aneurysm was completely occluded, global high-velocity flow could not be detected in the parent arteries （t = 2.57, P=0.03, constant）. CONCLUSION： When short-term high-velocity blood flow is present, aneurysms can be easily initiated and ruptured at the bifurcation of MCA.展开更多
A 51-year-old man presented with subarachnoid haemorrhage with mild hydrocephaly. Digital substraction angiography and 3-D Computerised Angiogram (CT) revealed a saccular aneurysm at bifurcation of azygos anterior cer...A 51-year-old man presented with subarachnoid haemorrhage with mild hydrocephaly. Digital substraction angiography and 3-D Computerised Angiogram (CT) revealed a saccular aneurysm at bifurcation of azygos anterior cerebral artery (ACA) and other vascular variations such as vertebral artery fenestration and hypoplasia in one anterior cerebral artery. We performed aneurysmal neck clipping with good outcome and postoperative 3-D CT angiogram showed complet obliteration of aneurysm. Although azygos arteries are rare in healthy population, aneurysms of azygos ASA are not rare due to increased haemodynamic stress. We wanted to point out to better visualisation of anatomical variations at 3-D CT angiogram comparing DSA in patients with intracranial aneurysm.展开更多
Variations of the anterior cerebral artery(ACA)-anterior communicating artery(ACo A) complex are commonly observed when associated with a symptomatic intracranial aneurysm. We report an asymptomatic ACo A aneurysm ass...Variations of the anterior cerebral artery(ACA)-anterior communicating artery(ACo A) complex are commonly observed when associated with a symptomatic intracranial aneurysm. We report an asymptomatic ACo A aneurysm associated with duplicated hypoplastic A1 segment of the right ACA, observed in a 70-year-old female cadaver. Furthermore, the aneurysm, practically substituting the ACo A, caused a remarkable depression on the internal surface of the right frontal lobe, anterior to the optic chiasm. Aneurysms and other anomalies of the ACA and ACo A are common and their microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy. Persistence of some embryonic vessels that normally disappear, disappearance of vessels that would normally persist or sprouting of new vessels due to hemodynamic and genetic factors are the usual causes for such anomalies. The high incidence of coexisting vascular anomalies and aneurysm suggests that such abnormalities predispose to aneurysm formation due to changes in the regional blood flow. A1 segment duplication has been reported to occur in 4% of subjects in cadaveric studies and in up to 0.5%-9.7% of cases of ACo A aneurysm surgery. Angiographic hypoplasias and aplasias of the A1 seg-ment have been also correlated with ACo A aneurysm patients.展开更多
With the development of radiography,especially digital subtraction cerebrovascular angiography,which is widely used in clinical practice,interventional embolization of intracranial aneurysms has become more and more p...With the development of radiography,especially digital subtraction cerebrovascular angiography,which is widely used in clinical practice,interventional embolization of intracranial aneurysms has become more and more popular due to its advantages of minimal invasiveness,high efficiency,and rapid postoperative recovery.The choice of patients,often we have to formulate an unconventional and individualized treatment plan based on the specific conditions of each patient’s blood vessel.This case is a segment A1 aneurysm of the right anterior cerebral artery.Due to its special location and wide diameter,in order to reduce the difficulty and risk of the operation during the operation,a bilateral internal carotid artery approach was developed to complete the stent-assisted procedure and special treatment plan for aneurysm embolization.展开更多
Purpose:The purpose of this study was to review the microsurgical anatomy and clipping of ruptured anterior communicating artery(AComA)aneurysms and to plan and avoid complications before operation.Methods:A total of ...Purpose:The purpose of this study was to review the microsurgical anatomy and clipping of ruptured anterior communicating artery(AComA)aneurysms and to plan and avoid complications before operation.Methods:A total of 523 cases of cerebral aneurysms admitted to the neurosurgery department of the Third Affiliated Hospital of Sun Yat-Sen University from September 2010 to October 2018 were analyzed retrospectively.Among them,85 patients had ruptured AComA aneurysms.This study was limited to 85 of these cases,whose satisfactory preoperative angiographic diagnostic films can be retrieved from the hospital database system because of the need for detailed review.Results:We performed supraorbital eyebrow keyhole approach(SOEK)craniotomy in 85 patients to clip 85 AComA aneurysms,in the setting of subarachnoid hemorrhage(SAH).Patients’mean age was(52.69±9.94)years(range,28e78 years).The proportions of small,medium and large aneurysms were 83.5%,15.3%,and 1.2%,respectively.The average size of the aneurysms was(5.07±2.36)mm.There were 77.8% of patients with inferior aneurysms and 81.3% of patients with superior aneurysms achieved good results.There was a significant correlation between A1 dominance and operation method(p<0.001).There was no significant relationship between surgical approach and aneurysm projection or A2 plane(p=0.157&p=0.318).Conclusion:Regardless of whether the A2 plane is open or closed,the A1 dominant side is still a better choice for accessing AComA aneurysms to avoid dangerous premature bleeding.展开更多
Azygos anterior cerebral artery (ACA) is type I variation of ACA with a reported incidence of < 1% in population(1)This variation predisposes to the formation of aneurysm especially at the bifurcation zone. The ane...Azygos anterior cerebral artery (ACA) is type I variation of ACA with a reported incidence of < 1% in population(1)This variation predisposes to the formation of aneurysm especially at the bifurcation zone. The aneurysm develops because of double hemodynamic pressure supplying medial surface of both cerebral hemispheres. However reported incidence of saccular aneurysm in azygos ACA is between 13% and 71%(2,3)It is often associated with other central nervous system (CNS) malformations like agenesis of corpus callosum, hydranencephaly and other vascular malformations[4].展开更多
基金Supported by Fujian Province Health Young and Middle-aged Backbone Personnel Training Project,No.2021GGB022Fujian Medical University Sailing Fund,No.2019QH1262.
文摘BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall,which is an independent risk factor for rupture and hemorrhage.Lobular aneurysms located in the anterior communicating artery complex account for 36.9%of all intracranial lobular aneurysms.Due to its special anatomical structure,both craniotomy and endovascular treatment are more difficult.Compared with single-capsule aneurysms,craniotomy for lobular intracranial aneurysms has a higher risk and complication rate.AIM To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm(ACoAA).METHODS Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included.Their demographic,clinical and imaging characteristics,endovascular treatment methods and follow-up results were collected.RESULTS A total of 24 patients with ruptured lobulated ACoAA were included,including 9 males(37.5%)and 15 females(62.5%).Their age was 56.2±8.9 years old(range 39-74).The time from rupture to endovascular treatment was 10.9±12.5 h.The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width were 3.0±0.7 mm.Nineteen patients(79.2%)were double-lobed and 5(20.8%)were multilobed.Fisher's grade:Grade 2 in 16 cases(66.7%),grade 3 in 6 cases(25%),and grade 4 in 2 cases(8.3%).Hunt-Hess grade:Grade 0-2 in 5 cases(20.8%),grade 3-5 in 19 cases(79.2%).Glasgow Coma Scale score:9-12 in 14 cases(58.3%),13-15 in 10 cases(41.7%).Immediately postprocedural Raymond-Roy grade:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Raymond-Roy grade in imaging follow-up for 2 wk to 3 months:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Followup for 2 to 12 months showed that 21 patients(87.5%)had good functional outcomes(modified Rankin Scale score≤2),and there were no deaths.CONCLUSION Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.
文摘Objective To report the clinical diagnosis and microsurgical treatment of ruptured distal anterior cerebral artery aneurysm (DACAA) patients treated over the last 3 years. Methods 9 consecutive cases of ruptured DACAA operated from October 2007 to March 2010 were reviewed and followed up. Results 11 aneurysms were clipped
基金the National Science & Technique Sup-porting Program in the 11th Five-Year Plan of China
文摘BACKGROUND： Hemodynamic changes accompany the initiation, development and rupture of middle cerebral artery （MCA） aneurysms. The complexity of the intraaneurysmal hemodynamic factors has not been completely clarified by the indirect measures and methods used in previous studies. OBJECTIVE： To evaluate correlations of intraoperative hemodynamic factors to initiation and rupture of MCA aneurysms. DESIGN, TIME AND SETTING： A case-control study was performed at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China between March and October 2008. PARTICIPANTS： A total of 12 consecutive patients diagnosed with MCA aneurysms （MCA aneurysms group） and five patients without middle cerebral artery aneurysms （with aneurysms located at other arteries, control group） were enrolled at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China. METHODS： The proximal and distal arteries of MCA aneurysms were exposed visibly in the MCA aneurysm group. The M1 segment of MCA without the aneurysm and the aneurysm on other arteries were also exposed visibly in the control group. Hemodynamic indices were then measured using an intraoperative 16 MHz probe installed in a Multi-Dop TCD8X4 device. MAIN OUTCOME MEASURES： Mean （time-averaged velocity） difference, maximum mean, pulsatility index difference, maximum pulsatility index, resistance index difference, maximum resistance index; correlation of development and rupture of MCA aneurysms to intraoperative hemodynamic factors of the parent artery. RESULTS： A total of 12 patients underwent microsurgery for treatment to occlude 15 MCA aneurysms. Of the 15 MCA aneurysms, 12 were located at the bifurcation, two at the M1 segment and one at the M3 segment; eight of the aneurysms were unruptured and seven were ruptured. The whole indices with combination mean difference, maximum mean, and maximum pulsatility index of the aneurysms were important factors influencing the rupture of MCA aneurysms （t = 2.92, P = 0.03, constant）. A higher velocity intraaneurismal flow at the bifurcation was identified （t = 3.48, P = 0.01, constant）. After the aneurysm was completely occluded, global high-velocity flow could not be detected in the parent arteries （t = 2.57, P=0.03, constant）. CONCLUSION： When short-term high-velocity blood flow is present, aneurysms can be easily initiated and ruptured at the bifurcation of MCA.
文摘A 51-year-old man presented with subarachnoid haemorrhage with mild hydrocephaly. Digital substraction angiography and 3-D Computerised Angiogram (CT) revealed a saccular aneurysm at bifurcation of azygos anterior cerebral artery (ACA) and other vascular variations such as vertebral artery fenestration and hypoplasia in one anterior cerebral artery. We performed aneurysmal neck clipping with good outcome and postoperative 3-D CT angiogram showed complet obliteration of aneurysm. Although azygos arteries are rare in healthy population, aneurysms of azygos ASA are not rare due to increased haemodynamic stress. We wanted to point out to better visualisation of anatomical variations at 3-D CT angiogram comparing DSA in patients with intracranial aneurysm.
文摘Variations of the anterior cerebral artery(ACA)-anterior communicating artery(ACo A) complex are commonly observed when associated with a symptomatic intracranial aneurysm. We report an asymptomatic ACo A aneurysm associated with duplicated hypoplastic A1 segment of the right ACA, observed in a 70-year-old female cadaver. Furthermore, the aneurysm, practically substituting the ACo A, caused a remarkable depression on the internal surface of the right frontal lobe, anterior to the optic chiasm. Aneurysms and other anomalies of the ACA and ACo A are common and their microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy. Persistence of some embryonic vessels that normally disappear, disappearance of vessels that would normally persist or sprouting of new vessels due to hemodynamic and genetic factors are the usual causes for such anomalies. The high incidence of coexisting vascular anomalies and aneurysm suggests that such abnormalities predispose to aneurysm formation due to changes in the regional blood flow. A1 segment duplication has been reported to occur in 4% of subjects in cadaveric studies and in up to 0.5%-9.7% of cases of ACo A aneurysm surgery. Angiographic hypoplasias and aplasias of the A1 seg-ment have been also correlated with ACo A aneurysm patients.
文摘With the development of radiography,especially digital subtraction cerebrovascular angiography,which is widely used in clinical practice,interventional embolization of intracranial aneurysms has become more and more popular due to its advantages of minimal invasiveness,high efficiency,and rapid postoperative recovery.The choice of patients,often we have to formulate an unconventional and individualized treatment plan based on the specific conditions of each patient’s blood vessel.This case is a segment A1 aneurysm of the right anterior cerebral artery.Due to its special location and wide diameter,in order to reduce the difficulty and risk of the operation during the operation,a bilateral internal carotid artery approach was developed to complete the stent-assisted procedure and special treatment plan for aneurysm embolization.
文摘Purpose:The purpose of this study was to review the microsurgical anatomy and clipping of ruptured anterior communicating artery(AComA)aneurysms and to plan and avoid complications before operation.Methods:A total of 523 cases of cerebral aneurysms admitted to the neurosurgery department of the Third Affiliated Hospital of Sun Yat-Sen University from September 2010 to October 2018 were analyzed retrospectively.Among them,85 patients had ruptured AComA aneurysms.This study was limited to 85 of these cases,whose satisfactory preoperative angiographic diagnostic films can be retrieved from the hospital database system because of the need for detailed review.Results:We performed supraorbital eyebrow keyhole approach(SOEK)craniotomy in 85 patients to clip 85 AComA aneurysms,in the setting of subarachnoid hemorrhage(SAH).Patients’mean age was(52.69±9.94)years(range,28e78 years).The proportions of small,medium and large aneurysms were 83.5%,15.3%,and 1.2%,respectively.The average size of the aneurysms was(5.07±2.36)mm.There were 77.8% of patients with inferior aneurysms and 81.3% of patients with superior aneurysms achieved good results.There was a significant correlation between A1 dominance and operation method(p<0.001).There was no significant relationship between surgical approach and aneurysm projection or A2 plane(p=0.157&p=0.318).Conclusion:Regardless of whether the A2 plane is open or closed,the A1 dominant side is still a better choice for accessing AComA aneurysms to avoid dangerous premature bleeding.
文摘Azygos anterior cerebral artery (ACA) is type I variation of ACA with a reported incidence of < 1% in population(1)This variation predisposes to the formation of aneurysm especially at the bifurcation zone. The aneurysm develops because of double hemodynamic pressure supplying medial surface of both cerebral hemispheres. However reported incidence of saccular aneurysm in azygos ACA is between 13% and 71%(2,3)It is often associated with other central nervous system (CNS) malformations like agenesis of corpus callosum, hydranencephaly and other vascular malformations[4].
