Discrepancy between Preoperative Imaging and Postoperative Pathological Finding of Ruptured Intracranial Dissecting Aneurysm, and Its Surgical Treatment: Case Report

Abstract

The choice of therapeutic strategy for intracranial dissecting aneurysm is often based on radiographic features, including characteristic geometry (e.g., irregular stenosis, segmental stenosis, aneurysm formation [pearl-and-string sign]), irregular fusiform or aneurysmal dilation, double lumen, and tapering occlusion. However, there is often a discrepancy between preoperative radiographic data and actual dissecting length. The present report describes three cases in which there was a discrepancy between preoperative radiographic data and actual dissecting length in patients undergoing direct trapping with or without revascularization. All three cases experienced good outcomes, but these cases underscore the fact that open surgery is a good option for management of ruptured intracranial dissecting aneurysms for determination of the rupture point, dissecting length, and the relationship between dissecting area and small arteries arising from the associated vessel.

Fusiform aneurysms: A review from its pathogenesis to treatment options

“…This report made by Ota et al . [ 17 ] describes three cases in which there was a discrepancy between preoperative radiographic data and postoperative pathological findings in patients undergoing direct trapping with or without revascularization. In these cases, irregular fusiform or aneurysmal dilatation resulted from the presence of the pseudolumen below the adventitia, while segmental stenosis resulted from decreased lumen and dissection at the media.…”

“…A possibility for its evolution is the disruption advance to the adventitia, rupturing the aneurysm and causing a subarachnoid hemorrhage (SAH), or it can be contained by the media layer, which will result in ischemia or stenosis of the artery caused by the enlargement of an aneurysm toward the artery lumen. [ 17 ] A propose for atherosclerotic fusiform aneurysms pathogenesis and evolution is that the initial event in the formation of the aneurysm is a lipid deposition in and beneath the intima. This disrupts the internal elastic membrane (IEM) and infiltrates the muscular wall.…”

“…One crucial factor to this is that preoperative imaging exams cannot define the exact size and range of a fusiform aneurysm or the location of the entry point when the dissection of the intimal IEM is present. [ 17 ] Therefore, the diagnostic imaging cannot precisely characterize the entry point of the dissection, what is crucial to define a surgical treatment plan. [ 16 17 ]…”

“…[ 17 ] Therefore, the diagnostic imaging cannot precisely characterize the entry point of the dissection, what is crucial to define a surgical treatment plan. [ 16 17 ]…”

Simultaneous Onset of Ischemic and Hemorrhagic Stroke Due To Intracranial Artery Dissection

“…Alternatively, endovascular strategies can be used, including proximal parent vessel occlusion, internal coil trapping, stent-assisted coil embolization, stent-only therapy, covered stent placement, or any combination thereof. 7) More recently, the deployment of a flow diverter stent has been used. 6) …”