Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992

Abstract

The paucity of information about giant fusiform intracranial aneurysms prompted this review of 120 surgically treated patients. Twenty-five aneurysms were located in the anterior and 95 in the posterior circulation. Six patients suffered from atherosclerosis and only three others had a known arteriopathy. The remaining 111 patients presented with aneurysms resulting from an unknown arterial disorder; these patients were much younger than those harboring atherosclerotic aneurysms. Mass effect occurred in only 50% of cases and hemorrhage in 20%. Eight aneurysms caused transient ischemic attacks. Hunterian proximal occlusion or trapping were dominant among the treatment methods. In contrast to the management of giant saccular aneurysms, the usual thrombotic occlusion of a giant fusiform aneurysm after proximal parent artery occlusion requires the presence of two collateral circulations to prevent infarction, one for the end vessels and another for the perforating vessels that arise from the aneurysm. Although there was some reliance on the circle of Willis and on collateral vessels manufactured at surgery, the extent of natural leptomeningeal and perforating collateral, thalamic, lenticulostriate, and brainstem vessels was astonishing and formerly unknown to the authors. Good outcome occurred in 76% of patients with aneurysms in the anterior circulation; two of the six cases with poor results included patients who were already hemiplegic. Ninety percent of patients with posterior cerebral aneurysms fared well. Only 67% of patients with basilar or vertebral aneurysms had good outcomes, although more (17%) of these patients were in poor condition preoperatively because of brainstem compression.

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) .…”

“…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) .…”

“…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) .…”

Treatment of an Unruptured Fusiform Aneurysm of the Internal Carotid Artery Associated With Wegener's Granulomatosis by Endovascular Balloon Occlusion

“…Surgical flow alteration has been reported as an effective therapy for such cases, 4,6) with excellent control rates and no new aneurysms in long-term follow up. 1,2,7) Early ischemic attacks are uncommon complications of proximal occlusion.…”