前交通动脉复合体发生变异对前交通动脉瘤治疗的指导  

The developmental variations of the anterior communicating artery complex and its clinical significance of the aneurysms

作　　者：赵兵[1] 钟鸣[1] 杨华[2] 刘健[2] 谭显西[1] 郑匡[1] 张明升[1] 尹剑[1] 

机构地区：[1]温州医学院附属第一医院神经外科,325000 [2]贵阳医学院附属医院神经外科

出　　处：《中华神经外科杂志》2009年第11期982-985,共4页Chinese Journal of Neurosurgery

基　　金：贵州省优秀科技教育人才省长专项（黔2005-100）;浙江省医药卫生科技项目（2008A117）

摘　　要：目的探讨前交通动脉（ACoA）复合体发生变异对ACoA动脉瘤治疗的指导意义。方法观察60具胚胎复合体形态变异；回顾夹闭29例，栓塞49例ACoA动脉瘤的临床资料。结果（1）大脑前动脉A1段（A1）成窗2例，发育不良15例，ACoA成窗12例，双支5例，胼胝体中央动脉4例，“Y”型4例，三支或以上1例，“H”型1例。复合体变异与性别差异无统计学意义，与胎龄无明显变化趋势。ACoA与A1变异无明显相关。（2）A1发育不良或缺如变异59例，ACoA双支2例，H型1例，瘤颈位于优势A1分叉部顶端55例，ACoA中间部19例，ACoA—A2段4例；术后无手术相关性死亡病例。结论A1，ACoA形态在胎儿早期普遍存在变异；A1发育不良在动脉瘤多见，ACoA形态并非多样，优势A1的处理有助于ACoA动脉瘤的成功治疗。Objective To study the variation and development of anterior communicating artery（ACoA） complex and their effects on the treatment of aneurysms. Method Sixty fresh fetal cadavers and their variations of ACoA complex were observed. Twenty - nine patients with ACoA aneurysms received clipping surgery and 49 patients received embolization treatment successfully. Results 1. There was A1 fenestration in 2 cases and dysplasia type in 15 cases. All variations of ACoA consisted of fenestration in 12 cases, duplication in 5, Y - shaped in 4, median artery of the corpus callosum in 4, plexiform in one, H - shaped in one. There was no significant difference between complex variations and the gender and age of patients. There was no significant correlation between variations of AI and ACoA. 2. A1 dysplasia or absence of 59 patients with aneurysm and ACoA variations of 3 patients were also observed. The necks of aneurysms were located on the apex of bifurcation of dominant A1. The middle segment of ACoA of 19 patients and the ACoA - A2 of 4 patients were also found. There was no death related to operative techniques. Condusions The variations of ACoA complex consequently exist early in fetal development. However, the variations of A1 dysplasia and single form of ACoA are observed in the patients with aneurysms. The operative techniques of dominant A1 are used to improve the safety of the treatment.

关 键 词：颅内动脉瘤 复合体 胚胎 治疗 

分 类 号：R686[医药卫生—骨科学]