Surgical treatment of traumatic distal anterior cerebral artery aneurysm: a report of nine cases from a single centre
Surgical treatment of traumatic distal anterior cerebral artery aneurysm: a report of nine cases from a single centre
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外伤性远端大脑前动脉瘤的手术治疗：附单中心9例报告
DOI：
10.1007/s00701-019-04121-x
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发表时间：
2019-12-04
影响因子：
2.4
通讯作者：
Gou, Dongsheng
中科院分区：
文献类型：
--
作者：
He, Yue;Wang, Ling;Gou, Dongsheng
研究背景外伤性大脑前动脉远端动脉瘤是一种少见的动脉瘤，在外伤患者中易被忽视和误诊。本研究的目的是探讨外伤性dACA动脉瘤的影像学特点和治疗策略，提高我们对外伤后罕见并发症的认识。方法回顾性分析2010年7月1日至2018年7月1日我院神经外科收治的9例外伤性dACA动脉瘤的临床资料。创伤后立即进行的首次计算机断层扫描显示8例蛛网膜下腔出血。迟发性颅内出血7例。损伤与诊断的平均间隔时间为13.67 ± 9.43天。9例均经CTA和/或DSA证实为外伤性dACA动脉瘤。根据Lehecka分类系统，外伤性dACA动脉瘤位于A3和A4段分别有3例和6例。手术治疗8例，其中瘤颈夹闭3例，瘤体夹闭4例，瘤体切除加栓塞1例，保守治疗1例。3例患者因重度脑积水需要脑室腹腔分流术。根据格拉斯哥预后评分系统，恢复良好4例，中残2例，重残1例，死亡2例。迟发性颅内出血和神经功能突然恶化是外伤性dACA动脉瘤的典型特征。CTA是创伤后出现胼胝体内出血的患者的一线筛查方式，特别是对于年龄较大、病情较差或危重的患者。当动脉瘤位于A4段或涉及一个小分支时，外科诱捕是首选的确定性治疗，以防止进一步生长和灾难性出血。早期诊断和及时治疗有助于改善临床结局。
BackgroundTraumatic distal anterior cerebral artery (dACA) aneurysm is rare and can be easily neglected and misdiagnosed in patients with trauma. The aim of this study was to explore the radiologic characteristics of and therapeutic strategies for traumatic dACA aneurysm and to improve our understanding of unusual complications after trauma.MethodsThe clinical data of nine cases of traumatic dACA aneurysm from our neurosurgical department from July 1, 2010, to July 1, 2018, were retrospectively analysed.ResultsAll 9 patients had a history of brain trauma. The initial computed tomography scan immediately after trauma showed subarachnoid haemorrhage in 8 cases. Among these cases, delayed intracranial haemorrhage occurred in 7 cases. The average interval between injury and diagnosis was 13.67 ± 9.43 days. All 9 cases were confirmed as traumatic dACA aneurysm by computed tomography angiography (CTA) and/or digital subtraction angiography. According to Lehecka’s classification system, traumatic dACA aneurysm located in the A3 and A4 segment was found in 3 and 6 cases, respectively. Surgical treatment was performed in 8 cases, including neck clipping, with or without wrapping in 3 cases, trapping in 4 cases, aneurysm excision and suturing in 1 case and conservative treatment in 1 case. Three patients required a ventriculoperitoneal shunt due to severe hydrocephalus. According to the Glasgow Outcome Scale scoring system, good recovery was achieved in 4 cases, moderate disability in 2 cases, severe disability in 1 case, and death in 2 cases.ConclusionTraumatic dACA aneurysm is a rare complication of brain trauma. Delayed intracranial haemorrhage and the sudden deterioration of neurologic function were the typical characteristics in patients with traumatic dACA aneurysm. CTA is the first-line screening modality for patients who present with intracerebral haemorrhage in the corpus callosum after trauma, particularly for patients who are older, in a poorer or critical condition. When the aneurysm is located in the A4 segment or involves a small branch, surgical trapping is the preferred definitive therapy to prevent further growth and disastrous bleeding. Early diagnosis and prompt treatment could help to improve clinical outcomes.