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首页> 外文期刊>The Open Neurosurgery Journal >Late Recurrence of Subarachnoid Hemorrhage Associated with Aneurysmal Regrowth Originating from the Anterior Communicating Artery after Neck Clipping
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Late Recurrence of Subarachnoid Hemorrhage Associated with Aneurysmal Regrowth Originating from the Anterior Communicating Artery after Neck Clipping

机译：蛛网膜下腔出血的晚期复发与夹颈术后前交通动脉引起的动脉瘤性再生长有关。

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摘要

While complete neck clipping of ruptured cerebral aneurysms prevents rerupture, recurrent subarachnoid hem-orrhage (SAH) due to the rupture of an aneurysm at the same sites of the previous aneurysm may occur, even if no resid-ual neck was detected during and after neck clipping. We present the cases of 3 patients with recurrent SAH due to re-growth after neck clipping of aneurysms at the anterior communicating artery (AComA). Two of the recurrent AComA aneurysms, accessed via the pterional approach, arose from the arterial wall adjacent to the previous necks; the third was a de novo aneurysm. Because their growth was in a posterior or superior direction, we posit that a portion of the neck was inadvertently not clipped during the first operation, and thus, flow in the AComA and perforators to the hypothalamus was maintained. Our findings suggest that unrecognized residual necks, vascular wall fragility around the earlier aneurysm, and hemodynamic changes following neck clipping contributed to their recurrence of SAH. Therefore, we recommend follow-up angiographic study to confirm complete neck clipping, especially in patients in whom the pterional approach was used.
机译：尽管完整的颈动脉瘤夹闭术可防止复发，但即使在颈内和颈后未发现残留颈，也可能由于先前动脉瘤相同部位的动脉瘤破裂而导致复发性蛛网膜下腔出血（SAH）剪裁。我们介绍了3例因前交通动脉（AComA）颈动脉瘤夹住颈后再生长而复发的SAH的病例。两次通过腹腔入路的AComA复发性动脉瘤是从与前颈部相邻的动脉壁产生的。第三个是新生的动脉瘤。由于它们的生长在后部或上方向，因此我们假定在第一次手术中会无意地夹住一部分颈部，从而保持了AComA和穿支肌向下丘脑的血流。我们的发现表明，无法识别的残留颈部，早期动脉瘤周围的血管壁脆性以及颈部夹闭后的血液动力学变化均导致SAH的复发。因此，我们建议进行后续的血管造影研究以确认完全的颈部夹闭，尤其是在采用翼状入路的患者中。

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