■大脑前动脉(ACA)A1段的动脉瘤很少见,并且具有将它们与其他颅内动脉瘤区分开的特征。他们的显微外科治疗具有挑战性,需要不同的策略。在这篇文章中,我们回顾了尸体解剖的ACAA1段的手术解剖,并以说明性病例描述了复杂A1动脉瘤的显微外科治疗。
■在福尔马林固定和硅胶注射的尸体头部上进行了右翼状开颅手术和Sylvian解剖,以描绘用于显微手术夹闭A1段动脉瘤的关键解剖结构和手术走廊。病例说明描述了ACAA1段破裂和未破裂动脉瘤的微神经外科治疗。
■ACA的A1段可以细分为近端,中间,和远端子段,前者有丰富的穿孔分支。接受显微外科夹闭治疗的两名患者均具有出色而持久的疗效,术后脑血管造影显示动脉瘤完全闭塞。
■小A1动脉瘤可能需要早期治疗,因为它们的破裂风险似乎更高。A1动脉瘤通常嵌入穿孔器,尤其是来自近端A1亚段的那些,并且需要小心的远端到近端显微解剖和动脉瘤夹片的战略放置。的方法,蛛网膜夹层,在考虑动脉瘤穹顶的投影后,仔细计划了攻角,动脉瘤颈部和穿孔器的精确位置,有无蛛网膜下腔出血。
UNASSIGNED: Aneurysms of the A1 segment of the anterior cerebral artery (ACA) are rare and have characteristics differentiating them from other intracranial aneurysms. Their microsurgical management is challenging and requires different strategies. In this article, we review the surgical anatomy of the A1 segment of the ACA with cadaveric dissections and describe the microsurgical management of complex A1 aneurysms with illustrative cases.
UNASSIGNED: A right pterional craniotomy and Sylvian dissection were performed on a formalin-fixed and silicone-injected cadaver head to depict the key anatomic structures and surgical corridors for microsurgical clipping of A1 segment aneurysms. The microneurosurgical management of ruptured and unruptured aneurysms of the A1 segment of the ACA is described with case illustrations.
UNASSIGNED: The A1 segment of the ACA can be subdivided into proximal, middle, and distal subsegments, the former having abundant perforating branches. Both patients treated with microsurgical clipping had excellent and durable outcomes and postoperative cerebral angiograms showed complete aneurysm occlusion.
UNASSIGNED: Small A1 aneurysms may require early treatment as their rupture risk appears to be higher. A1 aneurysms are usually embedded in perforators, especially those arising from the proximal A1 subsegment, and require careful distal to proximal microdissection and strategic placement of the aneurysm clip blades. The approach, arachnoid dissection, and angles of attack are carefully planned after accounting for the aneurysm dome projection, precise location of the aneurysm neck and perforators, and the presence or absence of subarachnoid hemorrhage.