WJNS  Vol.3 No.4 , November 2013
Intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography
ABSTRACT

The aim of this study is to examine morphology of intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography and discuss whether such aneurysms can be treated by interventional embolization. 6 patients who had not been treated by embolization due to irregular wide-necked aneurysms indistinguishable from surrounding artery branches by cerebral angiography received craniotomy for aneurysm clipping. The operations succeeded. Morphologically, neck width and location of the aneurysms were carefully observed and photographed from different directions and multi-angles during operation. The intraoperative findings were compared with the preoperative CTA and DSA images. Walls of the 6 patients’ aneurysms tightly clung to or adhered to surrounding branches and oppressed the branches into arcs, similar to the aneurysm walls in shape, and arterial branches and aneurysm walls suffered from segmental adhesion. In addition, abnormalities of communicating arteries to vary degrees were observed in 4 patients. However, after successful surgical clipping, it was revealed that the aneurysms would have been better treated by embolization since they are basically saccular aneurysms with regular sizes. Deformations in preoperative angiography may be due to anatomical variations of surrounding vessels near the aneurysms, aneurysm wall oppression or incomplete adhesion of surrounding arterial branches. Such deformations can be recognized by careful observation in preoperative angiography from different directions and multi-angles.

 


Cite this paper
Liu, Z. and Yuan, B. (2013) Intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography. World Journal of Neuroscience, 3, 293-297. doi: 10.4236/wjns.2013.34040.
References
[1]   Seibert, B., Tummala, R.P., Chow, R., Faridar, A., Mousavi, S.A. and Divani, A.A. (2011) Intracranial aneurysms: Review of current treatment options and outcomes. Frontiers in Neurology, 2, 45.
http://dx.doi.org/10.3389/fneur.2011.00045

[2]   McCormick, W.F. and Schochet Jr., S.S. (1976) Atlas of cerebrovascular disease. WB Saunders Co., Philadelphia, 422.

[3]   Vega, C., Kwoon, J.V. and Lavine, S.D. (2002) Intracranial aneurysms: Current evidence and clinical practice. American Family Physician, 66, 601-608.

[4]   Wolstenholme, J., Rivero-Arias, O., Gray, A., Molyneux, A.J., Kerr, R.S., Yarnold, J.A., Sneade, M. and International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2008) Treatment pathways, resource use, and costs of endovascular coiling versus surgical clipping after a SAH. Stroke, 39, 111-119.
http://dx.doi.org/10.1161/STROKEAHA.107.482570

[5]   Li, H., Pan, R., Wang, H., Rong, X., Yin, Z., Milgrom, D.P., Shi, X., Tang, Y. and Peng, Y. (2013) Clipping versus coiling for ruptured intracranial aneurysms: A systematic review and meta-analysis. Stroke, 44, 29-37.
http://dx.doi.org/10.1161/STROKEAHA.112.663559

[6]   McLaughlin, N., McArthur, D.L. and Martin, N.A. (2013) Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: A systematic review. Surgical Neurology International, 4, 43.
http://dx.doi.org/10.4103/2152-7806.109810

[7]   Hunt, W.E. and Hess, R.M. (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. Journal of Neurosurgery, 28, 14-20.
http://dx.doi.org/10.3171/jns.1968.28.1.0014

[8]   Benitez, R.P., Silva, M.T., Klem, J., Veznedaroglu, E. and Rosenwasser, R.H. (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery, 54, 1359-1368.
http://dx.doi.org/10.1227/01.NEU.0000124484.87635.CD

[9]   Li, M. (2000) Neuro-interventional radiology. Shanghai Science and Technology Literature Press, Shanghai, 60-70.

[10]   Chappell, E.T., Moure, F.C. and Good, M.C. (2003) Com-parison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: A meta-analysis. Neurosurgery, 52, 624-631.
http://dx.doi.org/10.1227/01.NEU.0000047895.82857.EB

[11]   Hirai, T., Korogi, Y., Ono, K., Murata, Y., Suginohara, K., Omori, T., Uemura, S. and Takahashi, M. (2001) Preoperative evaluation of intracranial aneurysms: Use-fulness of intraarterial 3D CT angiography and conventional angiography with a combined unit-initial experience. Radiology, 220, 499-505.

[12]   Landis, J.R. and Koch, G.G. (1977) The measurement of observer agreement for categorical data. Biometrics, 33, 159-174. http://dx.doi.org/10.2307/2529310

[13]   Wilson, G., Riggs, H. and Rupp, C. (1954) The pathologic anatomy of ruptured cerebral aneurysms. Journal of Neurosurgery, 11, 128-134.
http://dx.doi.org/10.3171/jns.1954.11.2.0128

[14]   Serizawa, T., Saeki, N. and Yamaura, A. (1997) Microsurgical anatomy and clinical significance of the anterior communicating artery and its perforating branches. Neurosurgery, 40, 1211-1218.
http://dx.doi.org/10.1097/00006123-199706000-00019

 
 
Top