Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms

Abstract

Dolichoectatic and fusiform aneurysms represent a small subset of cerebral aneurysms and are often among the most difficult to treat. A consecutive series of 40 patients with 41 of these two types of aneurysms is presented, including their clinical characteristics and surgical treatments. Common to all aneurysms was the pathological involvement of a length of blood vessel with separate inflow and outflow sites (nonsaccular). However, dolichoectatic aneurysms have markedly different symptoms and surgical treatments depending on their location in either the anterior or posterior circulation. Anterior circulation aneurysms involved the petrous internal carotid artery (ICA) in one, the supraclinoid ICA in three, the middle cerebral artery in 13, and the anterior cerebral artery in four patients. Posterior circulation aneurysms involved the basilar artery in 13, the vertebral artery in six, and the posterior inferior cerebellar artery in one patient. Various surgical procedures were performed, including direct clipping, trapping with bypass, proximal occlusion, resection with reanastomosis, transposition, aneurysmorrhaphy with thrombectomy, and wrapping. There was no surgical mortality in the patient series, and treatment was effective in many patients. Overall, outcome at late follow up was good (Glasgow Outcome Scale scores 1-2) in 78% of patients. Patients with anterior circulation aneurysms had better outcomes than patients with posterior circulation aneurysms, with good outcomes in 90% and 65% of the cases, respectively. Dolichoectatic and giant serpentine aneurysms may develop from smaller fusiform aneurysms and represent a spectrum of the same pathological entity. Arterial dissection may also play a role in the initial development of these aneurysms.

Progressive cervicocranial arteriopathy with dilatations and stenoses: case report

“…Damage to the IEL and to the intima may be crucial to the pathogenesis of FAs since these components are extremely important to vessel strength [4][5][6][7]11 . Observations in animals and humans support this hypothesis.…”

“…Etiopathogenic heterogeneity is suggested by descriptions of a number of wall abnormalities 1,[6][7][8][9][10][11] . The most frequent findings in affected arteries have been loss of medial layer components, collagen fiber degeneration, fibrosis, atherosclerotic changes and parietal thrombosis 7,8,10,11 . FAs have been associated with trauma, infection, inflammation, atherosclerosis, arterial dissection or neoplasms 4 .…”

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

“…They may present with ischemic complications associated with distal embolization, subarachnoid hemorrhage, or neurological deficit from the mass effect and compression of critical neuroanatomical structures. 1 These challenges are even more difficult in large or giant fusiform aneurysms. The pioneering work by Drake set the platform of understanding of flow dynamics in these lesions and set about forming the basis of many modern treatment strategies.…”

Reconstructive Endovascular Treatment of Intracranial Fusiform Aneurysms: A 1-Stage Procedure with Stent and Balloon

“…[6][7][8] Although some authors have treated these complex aneurysms by using surgical techniques, other authors have reported that internal trapping of the dissecting fusiform aneurysm is one of the most reliable treatment options. [9][10][11][12][13] Anson et al 14 reported surgical treatment of 41 dolichoectatic and fusiform aneurysms in patients with severe disability. Twenty-three percent of patients died, and follow-up results showed 17 unclippable wrapped fusiform aneurysms with 1 minor complication.…”