Anterior kominikan arter anevrizmalı olgularda hipotalamik arterlerin varyasyonları ve bu bölge anevrizmaları ile ilişkilerinin incelenmesi: Kadaverik çalışma
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Date
2010
Authors
Kuytu, Turgut
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Publisher
Uludağ Üniversitesi
Abstract
Anterior kominikan arter (ACoA) anevrizmaları tüm anevrizmalar içerisinde en büyük sayısal çoğunluğa sahiptir. Bölgedeki vasküler anatomi oldukça karmaşıktır. Anomali ve varyasyonlara sık rastlanması ve anevrizma oluşumu bu anatomiyi daha da karmaşık hale sokar. ACoA anevrizmalı olgularda klipleme esnasında ACoA'den çıkan perforan arterlerin korunması postoperatif morbidite ve mortalite açısından çok önemlidir.Bu çalışmada ACoA anevrizmalı olgularda ACoA orijinli perforan arterlerin lokalizasyonunda değişiklik olup olmadığı, varsa ne yönde olduğu ortaya konularak klipleme esnasında perforan dalların ne şekilde korunabileceği araştırıldı.Çalışmamızda kadavralardan elde edilen 40 beyinden iki grup oluşturuldu. 1. grup (n=26) ACoA yerleşimli anevrizması olmayan olgulardan, 2. grup (n=14) ise ACoA yerleşimli anevrizması olan olgulardandı.Beyinler, hazırlık aşamasından sonra cerrahi mikroskop altında disseke edilip ilgili anatomik bölge incelenerek fotoğraflandı. Her disseksiyon ve fotoğraflama işlemi sonrasında bilateral A1, A2, ACoA ve ACoA orjinli perforan arterlerin çizimleri yapılarak her iki grupta ACoA kaynaklı perforan arterlerin çıkış lokalizasyonu, sayısı, ACoA ile ilişkileri, A1'lerden birinin hipoplazik olduğu olgularda perforanların kalın olan A1 tarafına yakın olup olmadığı, anevrizmalı olgularda (2. grupta) perforan arter-anevrizma ilişkisi, anomaliler ve varyasyonlar not edildi. Takip eden süreçte çekilen ölçekli fotoğraflarda Photo Shop CS2 programı kullanılarak A1 ve A2'lerin çapları, ACoA çapı ve uzunluğu, ACoA kaynaklı perforan arterlerin çıkış (orifis) çaplarının ölçümleri yapıldı. En son aşamada verilerin istatistiksel analizi yapılarak sonuçlar dökümante edildi.Anterior projeksiyonlu ACoA anevrizmalarında perforan dallarla anevrizma arasında ilişki görülmezken özellikle superior ve posterior projeksiyonlu anevrizmalarda bu perforanların inferiora doğru itildiği ve sıklıkla anevrizma boynunun anteroinferiorunda bulunduğu görüldü. İnferior projeksiyonlu anevrizmalı tek olguda ise perforanların anevrizma boynunun lateralinden çıktığı görüldü.A1'lerin bir tarafta kalın olduğu olguların büyük kısmında perforan arterler kalın A1 tarafında izlendi.Olgulara dominant A1 tarafından yaklaşılması ve özellikle superior ve posterior projeksiyonlu anevrizmalarda bu perforanların öncelikle anevrizma boynunun anteroinferiorunda aranması perforan hasarına bağlı mortalite ve morbiditeyi azaltabilir.
Anterior communicating artery (ACoA) aneurysms represent the majority of the cases among all aneurysms. In this region, vascular anatomy is complex. The fact that anomalies and variations are frequent and the formation of aneurysm make the anatomy much more complex. In the patients with aneurysm of the ACoA, preserving the perforating arteries branching from the ACoA during clipping is of great importance for postoperative morbidity and mortality.In this study we aimed to investigate if perforating arteries originating from ACoA are pushed away in a different location in the patients with aneurysm of ACoA; if they do so, in which direction they are dislocated and how perforating arteries can be preserved during clipping.In our study we formed two groups from 40 brains obtained from cadavers. The first group (n=26) was formed by the cases without ACoA aneurysms, the second group (n=14) was formed by the cases with ACoA aneurysms.After preperation procedure was completed, the brains were dissected using surgical microscope, the relevant anatomical region was examined and photographed. After every dissection and photographing process, drawings of bilateral A1, A2, ACoA and perforating arteries originated from ACoA were done at each group; exit site, number of perforating arteries, their association with the ACoA, whether perforators were close to the thicker A1 in the patients having one hypoplastic A1, their association with the aneurysm in the patients with aneurysm (2. group), anomalies and variations were recorded. Subsequently, precise measurements of diameters of A1 and A2, the diameter and the length of the ACoA, and orifice sizes of perforating arteries arising from the ACoA were done on the photos taken with scale using Photo Shop CS2 software. Finally, statistical analyses of the data were done and the results were documented.It was seen that in the ACoA aneurysms with anterior projection, the perforators were located without any connection with the aneurysm. In the aneurysms with posterior and superior projections, it was seen that these perforators were pushed away inferiorly and were frequently seen at the anteroinferior part of the aneurysm neck. In one case with the aneurysm with inferior projection, the perforators were located at the lateral side of the aneurysm neck.In most of the cases in whom one of the A1s was larger at one side, the perforating arteries were arisen from the larger A1 side.To approach the patient from the dominant A1 side and in the aneurysms with superior and posterior projections, to pursue the perforators primarily at the anteroinferior part of the aneurysm neck can reduce the mortality and morbidity due to the damage to the perforators.
Anterior communicating artery (ACoA) aneurysms represent the majority of the cases among all aneurysms. In this region, vascular anatomy is complex. The fact that anomalies and variations are frequent and the formation of aneurysm make the anatomy much more complex. In the patients with aneurysm of the ACoA, preserving the perforating arteries branching from the ACoA during clipping is of great importance for postoperative morbidity and mortality.In this study we aimed to investigate if perforating arteries originating from ACoA are pushed away in a different location in the patients with aneurysm of ACoA; if they do so, in which direction they are dislocated and how perforating arteries can be preserved during clipping.In our study we formed two groups from 40 brains obtained from cadavers. The first group (n=26) was formed by the cases without ACoA aneurysms, the second group (n=14) was formed by the cases with ACoA aneurysms.After preperation procedure was completed, the brains were dissected using surgical microscope, the relevant anatomical region was examined and photographed. After every dissection and photographing process, drawings of bilateral A1, A2, ACoA and perforating arteries originated from ACoA were done at each group; exit site, number of perforating arteries, their association with the ACoA, whether perforators were close to the thicker A1 in the patients having one hypoplastic A1, their association with the aneurysm in the patients with aneurysm (2. group), anomalies and variations were recorded. Subsequently, precise measurements of diameters of A1 and A2, the diameter and the length of the ACoA, and orifice sizes of perforating arteries arising from the ACoA were done on the photos taken with scale using Photo Shop CS2 software. Finally, statistical analyses of the data were done and the results were documented.It was seen that in the ACoA aneurysms with anterior projection, the perforators were located without any connection with the aneurysm. In the aneurysms with posterior and superior projections, it was seen that these perforators were pushed away inferiorly and were frequently seen at the anteroinferior part of the aneurysm neck. In one case with the aneurysm with inferior projection, the perforators were located at the lateral side of the aneurysm neck.In most of the cases in whom one of the A1s was larger at one side, the perforating arteries were arisen from the larger A1 side.To approach the patient from the dominant A1 side and in the aneurysms with superior and posterior projections, to pursue the perforators primarily at the anteroinferior part of the aneurysm neck can reduce the mortality and morbidity due to the damage to the perforators.
Description
Keywords
Anterior kominikan arter, Mikrocerrahi anatomi, Perforan dallar, Anevrizma, Anterior communicating artery, Microsurgical anatomy, Perforating branches, Aneurysm
Citation
Kuytu, T. (2010). Anterior kominikan arter anevrizmalı olgularda hipotalamik arterlerin varyasyonları ve bu bölge anevrizmaları ile ilişkilerinin incelenmesi: Kadaverik çalışma. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.