Refusion of Anterior Cerebral Artery After Aneurysn Clipping - A Case Report

腦動脈血管瘤術後的血管重新灌注－病歷報告及文獻回顧

張志任(Chih-Zen Chang) ； 孫楨民(Zhen-Min Sun) ； 洪純隆(Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 13卷8期 (1997/08) Pp. 516-519

https://doi.org/10.6452/KJMS.199708.0516

摘要

腦部血流權注量和分配一直是決定腦動脈血管瘤術前和術後戲劇性變化的主要因素之一。腦部血管由雙側的內頸動脈和脊椎動脈形成的威利氏環供應。原則上藉由側支循環，左右大腦血管可互通有無。但是事實上並非如此，由於前中後大腦動脈和前後大腦交通動脈上均有交通枝來營養大腦。急性的缺血的權注不良往往造成不可逆的損害。大約有百分之二十五的成年人，他們的雙側前大腦動脈由單側內頸動脈來供應；百分之二十至三十的人的單側後大腦交通動脈不發達或無法在血管攝影上顯影。其發生原因並不十分清楚。在接受前大腦動脈血管瘤手術的病人，其術前和術後的腦血路動力學上微妙的變化，在文獻上很少被提到。在接受前大腦動脈血管瘤手術的病人中，有些會有單側或雙側前大腦動脈（A2）的梗塞，其原因可能是術中將供應單側或雙側前大腦動脈（A2）的前大脈動脈（A1) 夾住，而造成完全梗塞或狹窄。少見如本案歷原先由單側內頸動脈供應雙側前划斷動脈（ A2 ) , 在接受前大腦動脈（A1）血管瘤手術後，變成雙側內頸動脈供應雙側前大腦動脈。造成原因可能為一、暫時性的血管收縮；二、術中電燒燒灼造成血管阻塞；三、為動脈夾的翼壓迫前大腦交通動脈而造成動脈阻塞；四、原為部份通暢的右前大腦動脈（A1 ) ，在動脈血管瘤夾住手術後，血流量增加，變成完全通暢而營養右前大腦動脈（A2）末枝。比較術前術後的血管攝影，最可能的原因是四，第一、二、三可能性比較少。此病例術前術後血管攝影的差異及形成原因，頗令人玩味，為文獻上少見，特別提出來作為參考。

並列摘要

Herein, we are describing an unusual case suffering from a left anterior cerebral artery aneurysm (Al). Both the anterior cerebral arteries were supplied by the left internal carotid artery as was found in digital substraction anglography (DSA) preoperatively. The postoperative angiograms revealed that left anterior cerebral artery was supplied from the left internal carotid artery and the right anterior cerebral artery by the right internal carotid artery respectively. This finding of cerebral anglograms Is- interesting and rarely mentioned In the literature. Its hemodynamic change and patho— genesis were unclear and different to that of the coronary circulation, Ischemic change of gut and skeletal muscle. The causes may include: 1) vasospasm at the anterior communicating artery after manipulation at surgery; 2) desiccation or shrivelling the adjacent artery by intraoperative electrocoagulation; 3) occlusiOn the anterior communicating artery by the wing of clIp. 4) the deprivation of the blood flow from the left Internal carotid artery after totally or partially narrowing left Al by an aneurysm clip. The redistribution of blood volume in the previously hypoplastic right anterior cerebral artery and decreased caliber of the left anterior cerebral artery (Al) are likely playing a role in this case.

並列關鍵字

refusion ； digital substraction angiogrphy ； spontaneous subarachnoid hemorrhage