Giant fusiform aneurysms in the middle cerebral artery presenting with hemorrhages of different origins

Abstract

Three cases of giant fusiform aneurysms in the middle cerebral artery (MCA) presenting with hemorrhages of different origins are reported, and appropriate literature is reviewed to investigate the characteristics of these lesions. Two patients had suffered a subarachnoid hemorrhage and the other had an intramural hemorrhage (dissection). Pathologically, these aneurysms presented with hemorrhages of different origins; classic rupture type (Case 1), dissection type (Case 2), and atherosclerosis-related thrombosis type (Case 3). Based on surgical and pathological investigations in these three cases and a review of the reported literature, the authors propose that giant fusiform aneurysms in the MCA are characterized by weaknesses in the internal elastic lamina with intimal thickening. Therefore, these lesions have the potential to present with hemorrhage in each of the three types. This finding indicates that there is a strong relationship between the pathological features of giant fusiform aneurysms and their clinical course, and that it is necessary to determine appropriate therapy for giant fusiform aneurysms in the MCA by evaluating cerebral blood flow, even if the lesions are found incidentally.

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.…”

“…The last two terms seem to designate different degrees of progression of the same disease. 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 .…”

“…The presence of dilatations in cervical or cranial arteries is a phenomenon that has received diverse and somewhat imprecise denominations, such as dilatative arteriopathy 1 , arterial dysplasia 2 , dolichoectasia 3 and fusiform aneurysms (FAs) [4][5][6] . The last two terms seem to designate different degrees of progression of the same disease.…”

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

“…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) . 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) .…”

“…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.…”