前大脳動脈近位部(A1)動脈瘤の臨床像と治療成績

政之 金森, 弘樹 高沢, 慎悟 米澤, 俊介 面高, 奉洋 川口, 宏 緑川, 達也 佐々木, 西嶌 美知春
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Abstract

Aneurysms of the proximal anterior cerebral artery (A1) are rare. We investigated the clinical and angiographical characteristics, and treatment outcomes of A1 aneurysms by reviewing a total of 989 cases of ruptured or unruptured cerebral aneurysms treated with surgical clipping or coil embolization in our department and identified 12 cases of A1 aneurysms (1.2%), including 4 ruptured and 8 unruptured aneurysms. Three of the 4 patients with ruptured aneurysm were Grade IV or V in the classification of the World Federation of Neurosurgical Societies. Five of the 8 cases of unruptured A1 aneurysm were identified during examination for subarachnoid hemorrhage due to ruptured aneurysm at other sites. The A1 aneurysms were located on the proximal segment in 9 cases and projected posteriorly or superiorly in 11 cases. Symptomatic complications occurred in 2 of the 10 cases treated by surgical clipping: cerebral infarction of the genu of internal capsule causing transient motor aphasia in 1 patient, and visual field disturbance due to obstruction of a perforator originating from the A1 in the other patient. Considering the anatomical relationship, any perforator originating from the A1 should be carefully manipulated at surgical clipping.
前大脳动脉近位部(A1)动脉瘤の临床像と治疗成绩
大脑前动脉近端动脉瘤(A1)是罕见的。我们通过回顾我科989例经手术夹闭或线圈栓塞治疗的破裂或未破裂的脑动脉瘤,探讨A1动脉瘤的临床、血管造影特点及治疗效果,确定A1动脉瘤12例(1.2%),其中破裂4例,未破裂8例。4例动脉瘤破裂患者中有3例在世界神经外科学会联合会的分类中为IV级或V级。8例未破裂的A1动脉瘤中,有5例在检查时发现其他部位动脉瘤破裂所致的蛛网膜下腔出血。A1动脉瘤位于近段9例,后上方或后上方11例。手术夹持术治疗的10例患者中有2例出现症状性并发症:1例内囊膝脑梗死引起短暂性运动失语,另1例因起源于A1的穿支梗阻引起视野障碍。考虑到解剖关系,任何起源于A1的穿支在手术夹持时都应小心操作。
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