■颈内动脉(ICA)的缺失或发育不全是一种罕见的先天性异常,主要是单侧的,与其他颅内血管异常高度相关,其中囊状动脉瘤是最常见的。流向患侧循环的血流通过侧支途径维持,其中一些包括前交通动脉(Acom)作为其解剖结构的一部分。因此,单侧ICA异常患者在对Acom动脉瘤进行显微手术期间进行临时夹闭可能会危及这些侧支,并使患者面临缺血性损伤的风险.在本文中,我们回顾了与Acom动脉瘤相关的单侧ICA缺失病例的文献,并提供了一个说明性病例。
■我们将我们对一例与Acom动脉瘤相关的单侧ICA缺失病例的经验与文献中关于同一主题的33篇现有出版物相结合,共40例。我们提供了详细的系统的文献综述这种血管异常的关联,探索有关抵押品途径的不同方面,以及它们如何影响管理策略,并提出一种管理算法来处理这种关联。
■平均年龄为48.2±16.5岁。动脉瘤破裂是最常见的表现(75%)。70%的患者观察到发育不全,其次是发育不全(20%)和,最后,发育不全(10%)。A型谎言是最常见的络脉模式(50%),类型B和D的比例几乎相等。大多数动脉瘤位于异常侧对侧的A1-Acom交界处(Fisher精确检验;P=0.03)。文献中报道了1例临时剪裁。
■单侧ICA异常患者的Acom动脉瘤,鉴于它们更常见于对侧,可能是获得性病因,保证对无症状患者进行定期筛查。对于D型侧支模式的患者,临时夹闭可能是安全的,而A型或B型患者可能需要术中破裂风险评估和量身定制的管理计划,以避免破坏侧支血流和导致缺血。
UNASSIGNED: Absence or
hypoplasia of the internal carotid artery (ICA) is a rare congenital anomaly that is mostly unilateral and highly associated with other intracranial vascular anomalies, of which saccular aneurysm is the most common. Blood flow to the circulation of the affected side is maintained by collateral pathways, some of which include the anterior communicating artery (Acom) as part of their anatomy. Therefore, temporary clipping during microsurgery on Acom aneurysms in patients with unilateral ICA anomalies could jeopardize these collaterals and place the patient at risk of ischemic damage. In this paper, we
review the literature on cases with a unilaterally absent ICA associated with Acom aneurysms and provide an illustrative case.
UNASSIGNED: We combined our experience of one case of a unilaterally absent ICA associated with an Acom aneurysm with the 33 existing publications on the same subject in the literature, for a total of 40 cases. We provide a detailed systematic literature
review of this association of vascular anomalies, exploring different aspects regarding the collateral pathways and how they impact management strategies and propose a management algorithm to deal with such association.
UNASSIGNED: The mean age was 48.2 ± 16.5 years. The aneurysmal rupture was the most common presentation (75%). Agenesis was observed in 70% of patients, followed by
hypoplasia (20%) and, finally, aplasia (10%). Lie Type A was the most common pattern of collaterals (50%), with Types B and D being of almost equal proportions. Most aneurysms were located at the A1-Acom junction contralateral to the anomalous side (Fisher\'s Exact test; P = 0.03). One case of temporary clipping was reported in the literature.
UNASSIGNED: Acom aneurysms in patients with unilateral ICA anomalies, given they are more commonly present contralaterally, could be of acquired etiology, warranting periodic screening in asymptomatic patients. Temporary clipping might be safe in patients with Type D collateral pattern, while those with Types A or B may require intraoperative rupture risk assessment and a tailored management plan to avoid disrupting collateral flow and causing ischemia.