Journal of Korean Neurosurgical Society

  • 제62권6호
  • /
  • Pages.649-660
  • /
  • 2019
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Characteristics and Clinical Course of Fusiform Middle Cerebral Artery Aneurysms According to Location, Size, and Configuration

  • Seo, Dongwook (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lee, Si Un (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Oh, Chang Wan (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kwon, O-Ki (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Ban, Seung Pil (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Tackeun (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Byoun, Hyoung Soo (Department of Neurosurgery, Chungnam National University Hospital) ;
  • Kim, Young Deok (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lee, Yongjae (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Won, Yu Deok (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Bang, Jae Seung (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • 투고 : 2019.06.04
  • 심사 : 2019.07.26
  • 발행 : 2019.11.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration. Methods : We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ${\geq}10mm$; giant, ${\geq}25mm$), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm). Results : The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1. Conclusion : While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.

키워드

참고문헌

  1. Alturki AY, Schmalz PGR, Ogilvy CS, Thomas AJ : Sequential coilingassisted deployment of flow diverter for treatment of fusiform middle cerebral artery aneurysms. Oper Neurosurg (Hagerstown) 15 : E13-E18, 2018 https://doi.org/10.1093/ons/opx226
  2. Al-Yamany M, Ross IB : Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass. Br J Neurosurg 12 : 572-575, 1998 https://doi.org/10.1080/02688699844466
  3. Anson JA, Lawton MT, Spetzler RF : Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84 : 185-193, 1996 https://doi.org/10.3171/jns.1996.84.2.0185
  4. Borzone M, Altomonte M, Baldini M, Silvestro C, Rivano C : Giant fusiform aneurysm in middle cerebral artery branches: a report of two cases and a review of the literature. Acta Neurochir (Wien) 125 : 184-187, 1993 https://doi.org/10.1007/BF01401850
  5. Cohen MM, Hemalatha CP, D'Addario RT, Goldman HW : Embolization from a fusiform middle cerebral artery aneurysm. Stroke 11 : 158-161, 1980 https://doi.org/10.1161/01.STR.11.2.158
  6. Day AL, Gaposchkin CG, Yu CJ, Rivet DJ, Dacey RG Jr : Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 99 : 228-240, 2003 https://doi.org/10.3171/jns.2003.99.2.0228
  7. Devulapalli KK, Chowdhry SA, Bambakidis NC, Selman W, Hsu DP : Endovascular treatment of fusiform intracranial aneurysms. J Neurointerv Surg 5 : 110-116, 2013 https://doi.org/10.1136/neurintsurg-2011-010233
  8. Drake CG, Peerless SJ : Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87 : 141-162, 1997 https://doi.org/10.3171/jns.1997.87.2.0141
  9. Durst CR, Hixson HR, Schmitt P, Gingras JM, Crowley RW : Endovascular treatment of a fusiform aneurysm at the M3-M4 junction of the middle cerebral artery using the pipeline embolization device. World Neurosurg 86 : 511.e1-e4, 2016 https://doi.org/10.1016/j.wneu.2015.10.016
  10. Echiverri HC, Rubino FA, Gupta SR, Gujrati M : Fusiform aneurysm of the vertebrobasilar arterial system. Stroke 20 : 1741-1747, 1989 https://doi.org/10.1161/01.STR.20.12.1741
  11. Hanel RA, Spetzler RF : Surgical treatment of complex intracranial aneurysms. Neurosurgery 62 : 1289-1297; discussion 1297-1299, 2008
  12. Horie N, Takahashi N, Furuichi S, Mori K, Onizuka M, Tsutsumi K, et al. : Giant fusiform aneurysms in the middle cerebral artery presenting with hemorrhages of different origins. Report of three cases and review of the literature. J Neurosurg 99 : 391-396, 2003 https://doi.org/10.3171/jns.2003.99.2.0391
  13. Horowitz MB, Yonas H, Jungreis C, Hung TK : Management of a giant middle cerebral artery fusiform serpentine aneurysm with distal clip application and retrograde thrombosis: case report and review of the literature. Surg Neurol 41 : 221-225, 1994 https://doi.org/10.1016/0090-3019(94)90126-0
  14. Hrbac T, Drabek P, Klement P, Prochazka V : A combined approach to treatment of the dissecting middle cerebral artery fusiform aneurysm. A case report. Interv Neuroradiol 15 : 349-354, 2009 https://doi.org/10.1177/159101990901500314
  15. Jeong SM, Kang SH, Lee NJ, Lim DJ : Stent-assisted coil embolization for the proximal middle cerebral artery fusiform aneurysm. J Korean Neurosurg Soc 47 : 406-408, 2010 https://doi.org/10.3340/jkns.2010.47.5.406
  16. Kalani MY, Zabramski JM, Hu YC, Spetzler RF : Extracranial-intracranial bypass and vessel occlusion for the treatment of unclippable giant middle cerebral artery aneurysms. Neurosurgery 72 : 428-435; discussion 435-436, 2013 https://doi.org/10.1227/NEU.0b013e3182804381
  17. Kivipelto L, Niemela M, Meling T, Lehecka M, Lehto H, Hernesniemi J : Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree. J Neurosurg 120 : 398-408, 2014 https://doi.org/10.3171/2013.10.JNS13738
  18. Kobayashi N, Murayama Y, Yuki I, Ishibashi T, Ebara M, Arakawa H, et al. : Natural course of dissecting vertebrobasilar artery aneurysms without stroke. AJNR Am J Neuroradiol 35 : 1371-1375, 2014 https://doi.org/10.3174/ajnr.A3873
  19. Marinkovic S, Gibo H, Milisavljevic M, Cetkovic M : Anatomic and clinical correlations of the lenticulostriate arteries. Clin Anat 14 : 190-195, 2001 https://doi.org/10.1002/ca.1032
  20. Martin L, Reza D, Jaakko R, Rossana R, Riku K, Mika N, et al. : Surgical management of aneurysms of the middle cerebral artery : Schmidek and Sweet Operative Neurosurgical Techniques, ed 6. Beijing : Elsevier, 2012, pp897-913
  21. Miller MT, Pasquale M, Kurek S, White J, Martin P, Bannon K, et al. : Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma 56 : 967-972; discussion 972-973, 2004 https://doi.org/10.1097/01.TA.0000123699.16465.8B
  22. Mizutani T, Kojima H : Clinicopathological features of non-atherosclerotic cerebral arterial trunk aneurysms. Neuropathology 20 : 91-97, 2000 https://doi.org/10.1046/j.1440-1789.2000.00277.x
  23. Monteith SJ, Tsimpas A, Dumont AS, Tjoumakaris S, Gonzalez LF, Rosenwasser RH, et al. : Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device. J Neurosurg 120 : 945-954, 2014 https://doi.org/10.3171/2013.12.JNS13945
  24. Mrak G, Duric KS, Nemir J : Middle cerebral artery fusiform aneurysm presented with stroke and delayed subarachnoid hemorrhage trapping, thrombectomy, and bypass. Surg Neurol Int 7 : S209-S213, 2016 https://doi.org/10.4103/2152-7806.179571
  25. Nakajima H, Kamiyama H, Nakamura T, Takizawa K, Tokugawa J, Ohata K : Direct surgical treatment of giant middle cerebral artery aneurysms using microvascular reconstruction techniques. Neurol Med Chir (Tokyo) 52 : 56-61, 2012 https://doi.org/10.2176/nmc.52.56
  26. Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H, et al. : Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms : insight on the mechanism of growth. Stroke 31 : 896-900, 2000 https://doi.org/10.1161/01.STR.31.4.896
  27. Nasr DM, Flemming KD, Lanzino G, Cloft HJ, Kallmes DF, Murad MH, et al. : Natural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis. Cerebrovasc Dis 45 : 68-77, 2018 https://doi.org/10.1159/000486866
  28. Niikawa S, Yamada J, Sumi Y, Yamakawa H : Dissecting aneurysm of the middle cerebral artery manifesting as subarachnoid hemorrhage and hemorrhagic infarctions--case report. Neurol Med Chir (Tokyo) 42 : 62-66, 2002 https://doi.org/10.2176/nmc.42.62
  29. Park KW, Park JS, Hwang SC, Im SB, Shin WH, Kim BT : Vertebral artery dissection: natural history, clinical features and therapeutic considerations. J Korean Neurosurg Soc 44 : 109-115, 2008 https://doi.org/10.3340/jkns.2008.44.3.109
  30. Park SH, Yim MB, Lee CY, Kim E, Son EI : Intracranial fusiform aneurysms: it's pathogenesis, clinical characteristics and managements. J Korean Neurosurg Soc 44 : 116-123, 2008 https://doi.org/10.3340/jkns.2008.44.3.116
  31. Pumar JM, Lete I, Pardo MI, Vazquez-Herrero F, Blanco M : LEO stent monotherapy for the endovascular reconstruction of fusiform aneurysms of the middle cerebral artery. AJNR Am J Neuroradiol 29 : 1775-1776, 2008 https://doi.org/10.3174/ajnr.A1155
  32. Selviaridis P, Spiliotopoulos A, Antoniadis C, Kontopoulos V, Foroglou G : Fusiform aneurysm of the posterior cerebral artery: report of two cases. Acta Neurochir (Wien) 144 : 295-299; discussion 299, 2002 https://doi.org/10.1007/s007010200039
  33. Seo BR, Kim TS, Joo SP, Lee JM, Jang JW, Lee JK, et al. : Surgical strategies using cerebral revascularization in complex middle cerebral artery aneurysms. Clin Neurol Neurosurg 111 : 670-675, 2009 https://doi.org/10.1016/j.clineuro.2009.06.002
  34. Tayebi Meybodi A, Huang W, Benet A, Kola O, Lawton MT : Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization. J Neurosurg 127 : 463-479, 2017 https://doi.org/10.3171/2016.7.JNS16772
  35. Tse KM, Chiu P, Lee HP, Ho P : Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations. J Biomech 44 : 827-836, 2011 https://doi.org/10.1016/j.jbiomech.2010.12.014
  36. Vega-Basulto SD, Silva-Adan S, Laserda-Gallardo A, Penones-Montero R, Varela-Hernandez A : Giant supratentorial intracranial aneurysms. Analysis of 22 cases. Neurocirugia (Astur) 14 : 16-24, 2003 https://doi.org/10.1016/S1130-1473(03)70557-0
  37. Weddell JC, Kwack J, Imoukhuede PI, Masud A : Hemodynamic analysis in an idealized artery tree: differences in wall shear stress between Newtonian and non-Newtonian blood models. PLoS One 10 : e0124575, 2015 https://doi.org/10.1371/journal.pone.0124575
  38. Xu F, Xu B, Huang L, Xiong J, Gu Y, Lawton MT : Surgical treatment of large or giant fusiform middle cerebral artery aneurysms: a case series. World Neurosurg 115 : e252-e262, 2018 https://doi.org/10.1016/j.wneu.2018.04.031
  39. Yasui T, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M, Morikawa T : Evolution of incidentally-discovered fusiform aneurysms of the vertebrobasilar arterial system: neuroimaging features suggesting progressive aneurysm growth. Neurol Med Chir (Tokyo) 41 : 523-527; discussion 528, 2001 https://doi.org/10.2176/nmc.41.523
  40. Zhu W, Liu P, Tian Y, Gu Y, Xu B, Chen L, et al. : Complex middle cerebral artery aneurysms: a new classification based on the angioarchitecture and surgical strategies. Acta Neurochir (Wien) 155 : 1481-1491, 2013 https://doi.org/10.1007/s00701-013-1751-8