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Non-Atherosclerotic Fusiform Cerebral Aneurysms

Published online by Cambridge University Press:  02 December 2014

J. Max Findlay ,
Chunhai Hao  and
Derek Emery
J. Max Findlay
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
Chunhai Hao
Affiliation:
Division of Neuropathology, University of Alberta, Edmonton, Alberta, Canada
Derek Emery
Affiliation:
Division of Neuro-radiology, University of Alberta, Edmonton, Alberta, Canada
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Abstract

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Background:

Fusiform cerebral aneurysms are dilatations of the entire circumference of a segment of cerebral artery, usually considered due to atherosclerosis in adults. They are relatively thick-walled and elongated, causing neural compression or ischemia when discovered. We have noted a subset of fusiform cerebral aneurysms that vary from this common description.

Patients:

Out of a series of 472 intracranial aneurysms treated over 11 years, 11 patients between the ages 16 and 67 years (mean age 37) were identified who had discrete fusiform aneurysms unassociated with generalized cerebral atherosclerosis, connective tissue disorder or inflammation. Three presented with hemorrhage, six with neural compression by the aneurysm and two were discovered incidentally.

Results:

Nine aneurysms were located in the posterior circulation, the other two in the intracranial carotid artery. Their mean length and width were 16.3 and 11 mm, respectively. Three aneurysms contained thrombus. The eight aneurysms that were exposed surgically were partly or substantially thin-walled with normal appearing parent arteries. Eight were treated with proximal occlusion and three were circumferentially “wrapped”. Parent artery occlusion caused one death and one mild disability and the remaining patients made good recoveries (follow-up 0.5 - 10 years).

Conclusions:

There is a subset of cerebral aneurysms with discrete fusiform morphology, apparently unrelated to cerebral atherosclerosis or systemic connective tissue disease, thin-walled in part or whole, more common in the vertebrobasilar system, and possessing a risk of rupture. Treatments currently available include proximal occlusion or aneurysm “wrapping”, different approaches than neck-clipping or endovascular coiling of side-wall saccular cerebral aneurysms that leave the parent artery intact.

Résumé:

RÉSUMÉ:Introduction:

Les anévrismes cérébraux fusiformes sont des dilatations de toute la circonférence d'un segment d'artère cérébrale, habituellement attribuées à l'athérosclérose chez les adultes, avec une paroi relativement épaisse et allongée, causant des compressions nerveuses ou de l'ischémie lors du diagnostic. Nous avons observé un sous-groupe d'anévrismes cérébraux fusiformes qui diffère de cette description générale.

Patients:

Dans une série de 472 anévrismes intracrâniens traités sur une période de 11 ans, 11 patients entre l'âge de 16 et 67 ans (âge moyen 37 ans) ayant des anévrismes fusiformes discrets non associés à une athérosclérose cérébrale généralisée, à des maladies du tissu conjonctif ou à une maladie inflammatoire, ont été identifiés. Trois patients ont présenté une hémorragie, six une compression neurologique due à l'anévrisme et deux ont été découverts fortuitement.

Résultats:

Neuf anévrismes étaient localisés au niveau de la circulation postérieure, les deux autres dans la carotide intracrânienne. Leur longueur et leur largeur moyennes étaient de 16.3 et 11 mm respectivement. Trois anévrismes contenaient un thrombus. Les huit anévrismes qui ont été explorés chirurgicalement étaient en tout ou en partie des anévrismes à paroi mince et l'artère qui y avait donné naissance était d'apparence normale. Huit ont été traités au moyen d'une occlusion proximale et trois ont été “enveloppés”. L'occlusion de l'artère mère a provoqué un décès et un cas d'invalidité légère; les autres patients ont bien récupéré (suivi de 0.5 à 10 ans).

Conclusions :

Certains anévrismes cérébraux ont une morphologie fusiforme discrète, ne sont apparemment pas en relation avec une athérosclérose cérébrale ou une maladie systémique du tissu conjonctif, ont une paroi mince en tout ou en partie, sont plus fréquents au niveau du système vertébrobasilaire et sont à risque de rupture. Les traitements disponibles présentement sont l'occlusion proximale ou l'enveloppement de l'anévrisme, des approches différentes de la pose d'un clip ou d'une prothèse endovasculaire au niveau des anévrismes cérébraux sacculaires dont l'artère mère est intacte.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 1 , February 2002 , pp. 41 - 48
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

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