Fusiform aneurysm of the vertebrobasilar arterial system.

Abstract

We retrospectively evaluated the clinical features and therapeutic outcomes in 13 consecutive patients with the diagnosis of fusiform aneurysm of the vertebrobasilar system. Four patients (31%) presented with compressive symptoms and 10 (77%) with ischemic symptoms; one patient presented with both types of symptoms. No patient presented with rupture of the fusiform aneurysm. Based on the attending physician's choice, treatment included antiplatelet therapy in five patients, anticoagulation in seven, and no medication in one. Five patients died, four treated with antiplatelet agents and one not treated with any medication. The cause of death was progressive brainstem ischemia in three, sepsis in one, and gastrointestinal bleeding in one patient. All seven patients who received anticoagulants were alive, with no recurrence of symptoms or hemorrhagic complications after a mean follow-up period of 18 months. Based on previous and current series, we conclude that rupture of fusiform aneurysms is rare. Our results suggest a more favorable outcome in the management of these aneurysms with anticoagulation therapy to prevent progressive thrombosis and embolization.

Intracranial Fusiform Aneurysms: It's Pathogenesis, Clinical Characteristics and Managements

“…Conceptually, there is still confusion as to the etiological, clinical and radiological features of fusiform aneurysms. Several investigators have applied the term "atherosclerotic" as the cause of fusiform aneurysms [7][8][9]23,25) .…”

“…They represent about 3%-13% of all intracranial aneurysms 2) and are usually located in the vertebrobasilar system [7][8][9] . Fusiform aneurysms in the anterior circulation remain rare and occur mostly in the middle cerebral artery and internal carotid artery 6,13) .…”

“…Fusiform aneurysms in the anterior circulation remain rare and occur mostly in the middle cerebral artery and internal carotid artery 6,13) . There are some sporadic case reports about the treatment of fusiform aneurysms 2,4,13,34) and a few reports on the clinical characteristics, pathogenesis and treatment methods of these aneurysms in large series [6][7][8]11) . We have reviewed 22 cases of fusiform aneurysms that have been treated at our institute, and we describe the clinical characteristics, treatment methods and outcomes after management of patients with these lesions.…”

“…Fusiform aneurysms in this study were found in the anterior circulation in 17 (77%) of the patients and in the posterior circulation in 23%. Dissection has been proposed as the main underlying cause of fusiform aneurysms and most commonly involves the posterior circulation, especially vertebral and basilar arteries 1,3,[5][6][7][8][9][10]15,16,19,20,[24][25][26]32,35) However, typical cases of dissecting aneurysm in the posterior circulation were excluded in this study. Dissecting aneurysms can originate in any regions of the anterior circulation, such as the ICA 1,29) , MCA 2,4,6,10,[13][14][15][16]22,26,30) , the ACA 3,10,[16][17][18]24,27,30,32,35) and rarely in the anterior choroidal artery 21) .…”

“…Day et al 6) and several other authors 3,8,17,32,35) recommend that patients with stenotic or occlusive lesions presenting with acute ischemic symptoms should be treated conservatively. However, Kurino et al 16) reported a patient with a dissecting aneurysm in the MCA who presented with ischemic symptoms and who showed a poor outcome after conservative treatment.…”