A Pathological Study of Intracranial Posterior Circulation Dissecting Aneurysms with Subarachnoid Hemorrhage

Abstract

Three autopsied cases of dissecting aneurysms with spontaneous subarachnoid hemorrhage of the intracranial posterior circulation are reported, and the literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. The location and pathological features of the aneurysms were different in each of the cases presented. Subadventitial hemorrhage associated with the subarachnoid hemorrhage, multiple noncontiguous intramural hemorrhages, and new vessels in and around the arterial wall were noteworthy findings in our series. All 20 reported autopsied cases of the vertebrobasilar artery have a dissection between the media and adventitia with a rupture site in the thin adventitia. Seventeen of them had disruption of the entire arterial wall, but the remaining three cases had no apparent luminal connection. The clinicopathological features of this disease are various. On the basis of the pathological investigations of these reported cases, the pathogenesis of this lesion is discussed. Intramural hemorrhage associated with dissection without luminal connection should not be disregarded as a causative factor.

Endovascular coil embolization of parent artery for giant intracranial basilar artery dissection: a case report

“…However, this finding is seen in only about 13% of cases (11). These features along with a detectable intimal flap on FLAIR imaging of MRI is highly characteristics of a dissection (5,25). All these findings were present in our case.…”

“…BA dissection in patients over the age of 60 years tends to be of atherosclerotic in nature (5). Apart from atherosclerois, various causes such as trauma, fibromuscular dysplasia, sepsis, infective endocarditis, rheumatoid arthritis and hypercoagulability can also lead to dissection (5,15,22). Dissection in young adults below 18 years are extremely rare.…”

“…However, owing to limited data about its pathogenesis and natural course, the suitable therapeutic strategies for dissection of the BA remain controversial (2,7,14,20,21,25). Unlike dissection involving both VA and BA, isolated BA dissections are generally asymptomatic and rarely cause subarachnoid hemorrhage (2,3,5,7,25). As such, conservative management is recommended in most cases.…”

“…As such, conservative management is recommended in most cases. However, surgical interventions are essential for those patients with progressive deterioration secondary to rupture or bleeding (5,7,14,24). The current therapeutic options mainly include endovascular treatment, wrapping to reinforce the dissected wall, direct surgical ligation or clipping and arterial reconstruction (14,20,21,25).…”

Long-Term Follow Up of Antegrade Recanalization of Vertebral Artery Dissecting Aneurysm After Internal Trapping -Case Report-

“…3,[14][15][16]21,28) The subsequent healing process for cerebral dissecting aneurysms presenting with SAH and exhibiting neointimal proliferation is assumed to occur after 2 weeks. 13,14) Although the process might require more than a month, depending on the extent of the wall injury, rebleeding at more than a month after the onset of SAH is rare.…”