Fusiform vertebral artery aneurysms as a cause of dissecting aneurysms

1999 ◽  
Vol 91 (1) ◽  
pp. 139-144 ◽  
Author(s):  
Toshihiro Yasui ◽  
Masaki Komiyama ◽  
Misao Nishikawa ◽  
Hideki Nakajima ◽  
Yasutsugu Kobayashi ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Internal Elastic Lamina ◽  
Content Type ◽  
Pathological Characteristics ◽  
Vertebral Arteries ◽  
Cerebellar Artery ◽  
The Media ◽  
Dissecting Aneurysms ◽  
Elastic Lamina

✓ Two autopsy cases of angiographically determined fusiform aneurysms of the vertebral arteries (VAs) are reported and the appropriate literature is reviewed to investigate the pathological characteristics of both fusiform and dissecting VA aneurysms and the pathogenesis of dissecting aneurysms. One patient had suffered a subarachnoid hemorrhage (SAH) due to dissection of a previously documented incidental fusiform aneurysm. The other patient had harbored incidental fusiform aneurysms coexistent with a ruptured aneurysm of the posterior inferior cerebellar artery. The location and pathological features of the aneurysms were similar in the two cases. The aneurysms in both cases displayed intimal thickening, disruption of the internal elastic lamina, and degeneration of the media. A mural hemorrhage and patchy calcification were also found in the case that included SAH. Based on their pathological investigation of these two cases and a review of reported cases, the authors propose that incidental fusiform aneurysms in the VAs are characterized by weakness in the internal elastic lamina and, therefore, have the potential to become dissecting aneurysms, resulting in a fatal prognosis. This suggests that long-term control of blood pressure is mandatory in patients with incidental fusiform aneurysms in the VAs.

Intracranial dissecting aneurysms of the posterior circulation

1984 ◽  
Vol 61 (5) ◽  
pp. 882-894 ◽  
Author(s):  
Mitchel S. Berger ◽  
Charles B. Wilson
Keyword(s):  
Anticoagulation Therapy ◽  
Posterior Circulation ◽  
Cervical Region ◽  
High Morbidity ◽  
Internal Elastic Lamina ◽  
Content Type ◽  
Surgical Options ◽  
The Media ◽  
Dissecting Aneurysms ◽  
Elastic Lamina

✓ Dissecting aneurysms of the intracranial posterior circulation are unusual lesions that affect otherwise healthy young adults, are difficult to diagnose and manage, and carry a high morbidity and mortality rate. Headache in the suboccipital-posterior cervical region is the most common presenting symptom. The dissection usually occurs between the intima or internal elastic lamina and the media; subadventitial dissection does occur and accounts for the infrequent finding of subarachnoid hemorrhage. A deficit in the inner layers of the vessel is the proposed source of dissection. The angiographic features are inconsistent, although an irregularly narrowed arterial segment with proximal and/or distal dilatation are typical findings. Depending on the location of the dissection, the surgical options are: ligation, trapping, or reinforcement of exposed abnormal portions of the vessel. Anticoagulation therapy is not indicated in the management of this lesion.

Healing Process for Cerebral Dissecting Aneurysms Presenting with Subarachnoid Hemorrhage

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 342-348 ◽  
Author(s):  
Tohru Mizutani ◽  
Hideaki Kojima ◽  
Shunji Asamoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Healing Process ◽  
Superior Cerebellar Artery ◽  
Internal Elastic Lamina ◽  
Neointimal Proliferation ◽  
Specimen Collection ◽  
Cerebellar Artery ◽  
The Media ◽  
Wall Injury ◽  
Dissecting Aneurysms

Abstract OBJECTIVE This was a pathological study to investigate the healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage (SAH). METHODS Thirteen dissecting aneurysms that presented with SAH were obtained from 13 patients. Nine aneurysms arose from the vertebral artery, two arose from the anterior cerebral artery, one arose from the internal carotid artery, and one arose from the superior cerebellar artery. Eight aneurysm specimens were collected during autopsy and five were resected during surgery (trapping with or without bypass). The period between the onset of SAH and the time of specimen collection ranged from 6 hours to 35 days. All 13 aneurysms were pathologically examined with immunohistochemical staining, with a focus on the chronological healing process after SAH. RESULTS All dissecting aneurysms were generated with sudden widespread disruption of the internal elastic lamina and media. The healing process occurred with neointimal proliferation. The neointima, consisting mainly of newly synthesized smooth muscle cells and collagen fibers, extended from the disrupted ends of the media proper forward to the ruptured portion. CONCLUSION It is assumed that the healing process, with neointimal proliferation, begins after 1 week and may not be complete even after 1 month, depending on the extent of the wall injury.

Histological structural abnormalities of superficial temporal arteries used for extracranial-intracranial anastomosis

1982 ◽  
Vol 57 (3) ◽  
pp. 328-333 ◽  
Author(s):  
Fernando G. Diaz ◽  
Jacob Chason ◽  
Carl Shrontz ◽  
James I. Ausman ◽  
Manuel Dujovny
Keyword(s):  
Medical Condition ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Histological Evaluation ◽  
Elastic Tissue ◽  
Internal Elastic Lamina ◽  
Content Type ◽  
Temporal Arteries ◽  
The Media ◽  
Elastic Lamina

✓ Histological evaluation of the superficial temporal artery resected at the time of extracranial-intracranial anastomosis was performed in 64 consecutive patients. A neuropathologist who was not aware of the medical condition of these patients studied all specimens under light microscopy with hemotoxylin and eosin, Verhoff, and Mallory strains. Intimal proliferation was observed in 62 samples, intimal fibrosis in 56, fragmentation of the internal elastic lamina in 45, splitting of the internal elastic lamina in 41, fragmentation of the media in 38, and fragmentation of the minimal external elastic tissue in 17. Stenosis of the vessel was observed, and graded from 0% to 50%, with a mean of 20%. The development of intraluminal stenosis was considered to be secondary to the development of intimal fibrosis and hyperplasia. The changes observed were progressive and conformed with those previously described; there was no evidence of correlation with sex, diabetes, or hypertension. The implications for the development of occlusion of the anastomosis or stroke, and for patient survival are discussed.

Vertebral artery section for treating arterial compression of the medulla oblongata

1993 ◽  
Vol 79 (1) ◽  
pp. 116-118 ◽  
Author(s):  
Kazuhiro Hongo ◽  
Shigeaki Kobayashi ◽  
Masanobu Hokama ◽  
Kenichiro Sugita
Keyword(s):  
Vertebral Artery ◽  
Medulla Oblongata ◽  
Pyramidal Tract ◽  
Posterior Inferior Cerebellar Artery ◽  
Term Effect ◽  
Left Vertebral Artery ◽  
Content Type ◽  
Long Term Effect ◽  
Cerebellar Artery

✓ A case of a 30-year-old man who showed progressive pyramidal tract signs caused by compression of the left vertebral artery is presented. Initial decompression of the vertebral artery by placing a piece of sponge between the artery and medulla had no long-term effect. The left vertebral artery distal to the origin of the posterior inferior cerebellar artery was then sectioned, decompressing the medulla oblongata. The patient's symptoms improved postoperatively. This is the first reported case of brain-stem compression by an elongated vertebral artery treated by sectioning of the artery.

Distal posterior inferior cerebellar artery aneurysms: clinical features and management

2002 ◽  
Vol 97 (4) ◽  
pp. 756-766 ◽  
Author(s):  
Stephen B. Lewis ◽  
Dongwoo John Chang ◽  
David A. Peace ◽  
Pamela J. Lafrentz ◽  
Arthur L. Day
Keyword(s):  
Clinical Features ◽  
Posterior Inferior Cerebellar Artery ◽  
Pressure Effects ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Content Type ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Fine Print

Object. Aneurysms located on the distal portion of the posterior inferior cerebellar artery (PICA) are uncommon, and their underlying pathology, natural history, and clinical management are poorly understood. To clarify these lesions more fully, the authors undertook a retrospective analysis of the clinical features and management results of 22 distal PICA aneurysms in 20 consecutive patients treated at one institution by the same surgeon during the past decade. Methods. The series included 10 men and 10 women (mean age at presentation 51 years). Nine patients presented with only subarachnoid and/or intraventricular hemorrhage (median Hunt and Hess Grade II). In seven patients intracerebellar hemorrhage was also found; two patients presented with pressure effects and two hemorrhages were incidentally discovered. Prominent comorbidities included cigarette smoking (50%) and hypertension (50%). The 13 saccular and nine fusiform distal PICA aneurysms were distributed on the following segments of the PICA: lateral medullary (seven lesions), tonsillomedullary (five lesions), telovelotonsillar (five lesions), and cortical (five lesions). Six cases were associated with cerebellar arteriovenous malformations. Skull-base and far-lateral transcondylar surgical approaches were used to secure the aneurysms in 86% of cases, either by direct clipping (13 lesions), vessel sacrifice (four lesions), or vessel sacrifice plus bypass (two lesions). Two aneurysms were treated using endovascular PICA ablation. Overall outcome at hospital discharge was excellent or good in 70% of cases. At long-term follow up (100% of patients, mean 123 days), an excellent or good outcome had been achieved in 85% of cases. Conclusions. Depending on the PICA segment that was affected, variations in clipping strategies and surgical exposures aimed at the PICA branch and main trunk preservation were major contributors to good long-term results.

Cerebral dissecting aneurysms in patients with moyamoya disease

1983 ◽  
Vol 58 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Masanori Yamashita ◽  
Kenzo Tanaka ◽  
Takefumi Matsuo ◽  
Kazumasa Yokoyama ◽  
Toru Fujii ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Dissecting Aneurysm ◽  
Massive Hemorrhage ◽  
Internal Elastic Lamina ◽  
Content Type ◽  
The Right ◽  
Arterial Aneurysms ◽  
Dissecting Aneurysms ◽  
Elastic Lamina

✓ Dissecting intracranial arterial aneurysms were identified in a 16-year-old girl and a 48-year-old man with moyamoya disease. Hemiplegia or tetraplegia rapidly developed. Angiography revealed bilateral stenoses or occlusion of the bifurcation of the internal carotid arteries (ICA's) and an unusual vascular network at the base of the brain. Autopsy confirmed massive hemorrhage from the thalamus and putamen, with intraventricular extension. The intracranial segments of both ICA's were markedly stenotic in both patients, due to eccentric fibroelastic intimal thickening. In one patient, a dissecting aneurysm was identified microscopically, involving the proximal segment of the left anterior cerebral artery. In the other patient, the right middle cerebral artery (MCA) was dissected beneath the internal elastic lamina along the entire length of the horizontal segment of the MCA. Thus, cerebral dissecting aneurysms may be present in patients with moyamoya disease.

Abnormal origin of the posterior inferior cerebellar artery

1979 ◽  
Vol 51 (4) ◽  
pp. 569-571 ◽  
Author(s):  
Heinz Fankhauser ◽  
Shuji Kamano ◽  
Tetsu Hanamura ◽  
Kazuyoshi Amano ◽  
Hiroshi Hatanaka
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Sudden Onset ◽  
Content Type ◽  
Vertebral Arteries ◽  
Cerebellar Artery ◽  
Fine Print

✓ Posterior inferior cerebellar arteries originating from the vertebral arteries between the axis and the atlas were demonstrated angiographically in a 12-year-old boy. The patient presented with tetraparesis of sudden onset after a gymnastic exercise. There was no recognizable trauma.

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