Radiometric analysis of paraclinoid carotid artery aneurysms
Radiometric analysis of paraclinoid carotid artery aneurysms
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DOI：
10.3171/jns.2002.96.4.0649
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发表时间：
2002-04-01
影响因子：
4.1
通讯作者：
Kobayashi, S
中科院分区：
文献类型：
--
作者：
Tanaka, Y;Hongo, KZ;Kobayashi, S
Object.由于上级垂体动脉（SHAs）太细，在脑血管造影片上不易显示不透明，因此基于其相关分支动脉的床突旁颈动脉（CA）动脉瘤的分类一直令人困惑。作者对手术治疗的床突旁动脉瘤进行了回顾性放射性分析，以阐明其血管造影和解剖学特征。对85例硬膜内床突旁动脉瘤进行了回顾性分析，在手术夹闭时已确定存在或不存在分支动脉。根据CA侧位血管造影片上与前床突的关系，将病变分为床突上、床突和床突下动脉瘤。根据前后位血管造影片上穿过动脉瘤囊的水平线的内侧部分与动脉瘤颈中心之间的夹角来测量动脉瘤的方向，68个动脉瘤伴有分支动脉，其中28个为眼动脉（OphA）病变SHA动脉瘤40个（47.1%），17个（20%）动脉瘤无相关分支动脉。25个动脉瘤（29.4%）位于床突上段，46个（54.1%）位于床突，14个（16.5%）位于床突下。在床突上段发现的大多数动脉瘤为OphA病变（44%）或与分支动脉无关的动脉瘤（48%），平均方向分别为57 °或67 °。在床突水平，6个与分支动脉无关的动脉瘤的平均方向为76 °（13%），16个OphA动脉瘤的平均方向为43 °（35%），24个SHA动脉瘤的平均方向为-11 °（52%）。所有床突下水平的动脉瘤均起源于SHA的起源处，平均方向为-29 °，大多数嵌在颈动脉腔中。通过脑血管造影，可以将SHA引起的动脉瘤与那些不位于动脉分区的动脉瘤区分开来，因为SHA病变通常位于床突或床突下水平的颈内动脉内侧或内侧下壁。它们的分布与报告的SHA起源分布相关性很好。颈动脉腔瘤是一种起源于最近端硬膜内CA的SHA病变。
Object. Classification of paraclinoid carotid artery (CA) aneurysms based on their associated branching arteries has been confusing because superior hypophyseal arteries (SHAs) are too fine to appear opacified on cerebral angiograms, The authors performed a retrospective radiometric analysis of surgically treated paraclinoid aneurysms to elucidate their angiographic and anatomical characteristics.Methods. A retrospective analysis was made of 85 intradural paraclinoid aneurysms in which the presence or absence of branching arteries had been determined at the time of surgical clipping. The lesions were classified as supraclinoid, clinoid, and infraclinoid aneurysms based on their relation to the anterior clinoid process on lateral angiograms of the CA. The direction of the aneurysms were measured according to angles formed between the medial portion of the horizontal line crossing the aneurysm sac and the center of the aneurysm neck on anteroposterior angiograms.Branching arteries were associated with 68 aneurysms, of which 28 were ophthalmic artery (OphA) lesions (32.9%) and 40 were SHA ones (47.1%); associated branching arteries were absent in 17 aneurysms (20%). Twenty-five aneurysms (29.4%) were located at the supraclinoidal level, 46 (54.1%) at the clinoidal, and 14 (16.5%) at the infraclinoidal. The majority of aneurysms identified at the supraclinoidal level were OphA lesions (44%) or those unassociated with branching arteries (48%), with mean directions of 57degrees or 67degrees, respectively. At the clinoidal level, the mean directions of aneurysms were 76degrees in six lesions unassociated with branching arteries (13%), 43degrees in 16 OphA lesions (35%), and -11degrees in 24 SHA ones (52%). All aneurysms at the infraclinoidal level arose at the origin of the SHAs, with a mean direction of -29degrees, and most of these were embedded in the carotid cave.Conclusions. Aneurysms arising from the SHA can be distinguished from those not located at an arterial division by cerebral angiography, because SHA lesions are usually located at the medial or inferomedial wall of the internal carotid artery at the clinoidal or infraclinoidal level. Their distribution correlates well with the reported distribution of SHA origins. The carotid cave aneurysm is a kind of SHA lesion that originates at the most proximal intradural CA.