| Objective: To study the clinical features,imaging features,operative timing,operative approach,perioperative complications and clinical prognosis of distal anterior cerebral artery aneuysms,and the clinicaldata of different Hunt-Hess grading patients were analyzed and compared.Explore the efficacy and safety of surgical treatment.Methods: Clinical data of 59 patients with distal anterior cerebral artery aneurysms admitted to neurosurgery department of the Affiliated Hospital of Qingdao University from June 1997 to June 2018 were retrospectively analyzed.Records include: patient’s age,gender,clinical manifestations,imaging features,position and size of distal anterior cerebral artery aneurysms,operation timing,operation approach,operation skills,perioperative complications and clinical prognosis.According to the Hunt-Hess grading scale,the degree of preoperative condition of the patients was evaluated,and the patients were divided into Hunt-Hess grade 0-Ⅲ group(50 cases,84.7%)and IV-V grade group(9cases,15.3%).GOS score was used to evaluate prognosis.The differences in clinical data between the two groups were analyzed and compared.Results: 1.The 59 patients’ gender and age distribution characteristics in this data were as follows: male 30(50.8%),female 29(49.2%),male and female 1.03:1;The minimum age was 35 years,the maximum age was 71 years,the average age was(53.37± 8.99)years,40-60 years was the peak age of onset.2.Clinical manifestations and imaging features:47 patients(79.7%)in this 59 cases data with sudden headache,42 patients(71.2%)with nausea and vomiting,7 patients(11.9%)with dyskinesia,3 patients(5.1%)with seizures,36 patients(61.0%)with clear mind,14 patients(23.7%)with light coma,moderate coma occurred in 9 patients(15.3%).Therefore,all patients underwent brain CT examination,including aneurysmal subarachnoid hemorrhage in 56 patients(94.9%)and unruptured aneurysm in 3 patients(5.1%).There were 17 cases(28.8%)with frontal hematoma and 13 cases(22.0%)with intraventricular hemorrhage.3.Aneurysm characteristics: 46 cases(78.0%)of the distal anterior cerebral artery were located in the A3 segment and the most common site was the pericallosal artery and callosomarginal artery junction.There were 9 cases(15.3%)in A2 segment and 4 cases(6.8%)in A4 and A5 segments.They were mainly small aneurysms(<5 mm)in 37 cases(62.7%),There were 16 cases(27.1%)of common aneurysms(≥5mm-<15mm),Large aneurysms(≥ 15 mm-<25 mm)were found in 4 cases(6.8%),giant aneurysms(≥25 mm)in 2 cases(3.4%),and multiple aneurysms in 10 cases(16.9%).4.Surgical treatment: operation time: 30 cases(50.8%)in early operation group,21cases(35.6%)in intermediate operation group and 8 cases(13.6%)in delayed operation group.Surgical approach: Longitudinal fissure approach was used in 46 cases(78.0%),and pterion approach was used in 13 cases(22.0%).5.Perioperative complications: A total of 13 patients(22.0%)suffered from periprocedural complications among 59 patients in this data,including 6 cases(10.2%)of aneurysm rupture during operation;Postoperative neurological complications occurred in7 patients(11.9%),including postoperative rebleeding in 1 patient(1.7%),massive cerebral infarction in 1 patient(1.7%),cerebral infarction in 1 patient(1.7%),hydrocephalus in 3 patients(5.1%)and brain swelling in 1 patient(1.7%).Postoperative death occurred in 3 patients(5.1%).6.Prognostic evaluation: At 3 months after the operation,all the 59 patients with distal anterior cerebral artery aneurysms were evaluated by GOS.The prognosis was good in 52 cases(88.1%)and bad in 7 cases(11.9%).7.Comparison of clinical data between the two groups: Compared with Hunt-Hess grade 0-III group,grade IV-V patients had more common frontal hematoma(18.0% vs88.9%,P < 0.001)and intraventricular hemorrhage(16.0% vs 55.6%,P = 0.019),and more perioperative complications(10.0% vs 88.9%,P < 0.001),worse prognosis at 3months after operation.(4.0% vs 55.6%,P < 0.001).Conclusion: 1.Distal anterior cerebral artery aneuysms often accompanied by frontal lobe hematoma and ventricular hemorrhage;It is mostly located in A3 segment,the most common site was the junction of the pericallosal artery and callosomarginal artery,mainly small aneurysms,which most of the patients were surgically treated in the early stage,usually with longitudinal fissure approach.2.Compared with Hunt-Hess grade 0-Ⅲgroup,patients in grade Ⅳ-Ⅴ group had more common frontal hematoma and ventricular hemorrhage,more perioperative complications,and worse prognosis at 3 months after operation.Craniotomy for distal anterior cerebral artery aneurysms is a safe and effective treatment with fewer perioperative complications,low mortality and good prognosis. |
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