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Surgical treatment of traumatic distal anterior cerebral artery aneurysm: a report of nine cases from a single centre

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单位: [1]Huazhong Univ Sci & Technol,Dept Neurosurg,Tongji Hosp,Tongji Med Coll,Wuhan 430030,Hubei,Peoples R China [2]Huazhong Univ Sci & Technol,Tongji Med Coll,Tongji Hosp,Dept Operating Room,Wuhan 430030,Hubei,Peoples R China [3]Jianghan Oilfield Cent Hosp, Dept Neurosurg, Qianjiang 433100, Hubei, Peoples R China
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关键词: Traumatic Anterior cerebral artery Distal Microsurgery Treatment

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Background Traumatic 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. Methods The clinical data of nine cases of traumatic dACA aneurysm from our neurosurgical department from July 1, 2010, to July 1, 2018, were retrospectively analysed. Results All 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. Conclusion Traumatic 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.

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出版当年[2019]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 外科
最新[2025]版:
大类 | 3 区 医学
小类 | 3 区 外科 4 区 临床神经病学
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出版当年[2018]版:
Q3 SURGERY Q3 CLINICAL NEUROLOGY
最新[2023]版:
Q2 SURGERY Q3 CLINICAL NEUROLOGY

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第一作者单位: [1]Huazhong Univ Sci & Technol,Dept Neurosurg,Tongji Hosp,Tongji Med Coll,Wuhan 430030,Hubei,Peoples R China
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