Geometry of saccular cerebral aneurysms not associated with a branch vessel.

Publisher: Saunders Country of Publication: United States NLM ID: 9111633 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8511 (Electronic) Linking ISSN: 10523057 NLM ISO Abbreviation: J Stroke Cerebrovasc Dis Subsets: MEDLINE

Publication: Philadelphia, PA : Saunders
Original Publication: New York, NY : Demos Publications, [1991-

Carotid Artery, Internal*/diagnostic imaging ; Carotid Artery, Internal*/pathology ; Carotid Artery, Internal*/physiopathology ; Carotid Artery, Internal*/surgery ; Cerebral Angiography*/methods ; Cerebral Arteries*/diagnostic imaging ; Cerebral Arteries*/pathology ; Cerebral Arteries*/physiopathology ; Cerebral Arteries*/surgery ; Vertebral Artery*/diagnostic imaging ; Vertebral Artery*/pathology ; Vertebral Artery*/physiopathology ; Vertebral Artery*/surgery; Intracranial Aneurysm/*diagnosis; Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Cerebrovascular Circulation ; Endovascular Procedures ; Female ; Humans ; Intracranial Aneurysm/physiopathology ; Intracranial Aneurysm/surgery ; Magnetic Resonance Angiography ; Male ; Microsurgery ; Middle Aged ; Patient Selection ; Tomography, X-Ray Computed ; Vascular Patency ; Young Adult

Objective: Saccular cerebral aneurysms located at nonbranching sites are uncommon. Their distribution, morphological features, and presence of a branch vessel or a tiny perforator(s) separate from the aneurysm neck were investigated.
Methods: From a series of 303 microsurgically clipped saccular cerebral aneurysms, 40 aneurysms were identified at sites not related to a branch vessel.
Results: The distribution of aneurysms at nonbranching sites was internal carotid: 21 of 40 (52.5%); main stem of the middle cerebral artery/secondary branch of the middle cerebral artery: 6 of 40 (15%); anterior cerebral artery: 1 of 40 (2.5%); pericallosal artery: 1 of 40 (2.5%); pericallosal/callosal marginal: 3 of 40 (7.5%); vertebral artery: 1 of 40 (2.5%); posterior cerebral artery: 1 of 40 (2.5%); posterior cerebral artery/secondary branch of the posterior cerebral artery: 1 of 40 (2.5%); anterior inferior cerebellar artery: 1 of 40 (2.5%); and distal posterior inferior cerebellar artery: 1 of 40 (2.5%). Branch vessels were seen in 5 cases, and small perforating vessels were observed in 2 instances.
Conclusions: Saccular aneurysms occurring at nonbranching sites are uncommon. Their geometry is particularly favorable for flow directed stents and is most amenable to aneurysms located on large-diameter conducting vessels such as the internal carotid, vertebral, and vertebrobasilar vessels. Smaller parent arteries harboring this type of aneurysm will require new technology to maintain patency of these more distal vessels. If endovascular techniques cannot achieve aneurysm sac obliteration, then open craniotomy and aneurysm clipping will provide a satisfactory alternative.
(Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Keywords: Cerebral arteries; intracranial aneurysm; saccular aneurysm; treatment

Date Created: 20130611 Date Completed: 20141114 Latest Revision: 20161125

20231215

10.1016/j.jstrokecerebrovasdis.2013.05.006

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