기형 뇌동맥에 발생한 뇌동맥류 환자 72명의 임상 경험

Abstract

Objective : Aneurysm rupture at the anomalous artery is rare but inadvertent clip occlusion may cause critical complications. The aim of this study was to examine the frequency of the cerebral aneurysms associate with the vascular anomalies and the surgical considerations. Methods : We analyzed 2802 patients with aneurysms treated from September, 1976 to July, 2004. A diagnosis of 'anomalous artery ' was made on the basis of angiographic or surgical findings in 72 patients. Surgery was carried out in 68 patients and 4 were treated with endovascular methods. Results : Fenestrated anterior communicating artery (A-com.) was the most common anomaly (33cases, 45. 8%), 24 cases of 3rd A2 (33.3%), and 9 cases of azygous A2 (12.5%). fenestrated M1 was 1 cases (1.4%) and the one duplicated MCA (1. 4%). 3 cases of fenestrated basilar artery (4.2%) and one primitive trigeminal artery aneurysm (1.4%) were treated with GDC. In our series vascular anomalies were found in 6% of the all Acom aneurysm cases. Conclusion : It is often difficult to recognize a fenestration or other anomalies of cerebral arteries prior to surgery, even with precise angiographic analysis. The A-com artery complex is one of most frequent sites of vascular anomalies. Preoperative and intraoperative concerns is required to avoid inadvertent occlusion of parent artery or misplacement of clip, which may result in critical complications or poor outcomes.