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虽然前交通动脉瘤(ACoAA)是引起蛛网膜下腔出血的常见原因,但其引起的视力障碍者并不多见。本文报道一例因ACoAA破裂导致视力视野障碍的病例。 40岁男性患者,无明显原因出现左侧突发性同向偏盲,右眼视力急剧下降(眼前数指)和轻微头痛。CT平扫及增强扫描提示为ACoAA,并有部分瘤内血栓形成,右侧颈内动脉造影显示一突向下方的约7mm大小的ACoAA。除视力症状外无其它神经系统障碍。术中见视交叉周围蛛网膜下腔可见少量凝血块。动脉瘤起于右侧大脑前动脉A_1和A_2段结合部并突向下方,穿透了视交叉的右侧部分并压迫右侧视束。术中夹闭瘤颈并将包埋在视交叉内的动脉瘤体分离出来予以切除,瘤体内可见血栓。术后病情平稳,但视力障碍无好转,血管造影显示动脉瘤已完全夹闭。
Although anterior communicating artery aneurysm (ACoAA) is a common cause of subarachnoid hemorrhage, it is rare in the visually impaired. This article reports a case of visual field disorders caused by ACoAA rupture. 40-year-old male patient, there is no obvious reason for sudden left hemianopia on the left side, sharp decline in visual acuity (index finger) and mild headache. CT scan and enhanced scan prompt for ACoAA, and some of the tumor thrombus formation, right internal carotid artery angiography showed a sudden downward ACoAA about 7mm size. No other neurological disorders except visual acuity symptoms. Visible intraoperative visualization of subarachnoid space around a small amount of clotting. The aneurysm starts at the junction of segments A_1 and A_2 of the right anterior cerebral artery and protrudes downward, penetrating the right part of the optic chiasm and compressing the right optic tract. Clamp tumor neck surgery and will be embedded in the optic chiasm within the aneurysm isolated to be removed, the tumor was visible thrombus. Postoperative stable condition, but no improvement in visual impairment, angiography showed aneurysm has been completely clipped.