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Ruptured irregularly shaped aneurysms: pseudoaneurysm formation in a thrombus located at the rupture site
1Department of Neurosurgery, Kanazawa University School of Medicine, Japan. mnomura@aecom.yu.edu
Journal of Neurosurgery
|December 16, 2000
Summary
Irregularly shaped cerebral aneurysms pose a high risk of re-rupture during endovascular treatment due to fragile pseudoaneurysm cavities. Careful surgical navigation is crucial to avoid these delicate areas.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Ruptured cerebral aneurysms with irregular shapes present unique challenges in treatment.
- Understanding the specific radiological and pathological features is essential for effective management.
Purpose of the Study:
- To describe the clinical, radiological, and pathological findings of ruptured cerebral aneurysms with irregular configurations.
- To evaluate the safety and efficacy of endovascular and open surgical interventions for these specific aneurysm types.
Main Methods:
- Retrospective analysis of eight patients with subarachnoid hemorrhage from irregularly shaped aneurysms.
- Comparison of preoperative imaging (DSA, CT) with intraoperative and pathological findings.
- Review of treatment outcomes for endovascular embolization and open surgical clipping.
Main Results:
- Irregular aneurysms showed delayed contrast opacification and washout on angiography and CT.
- Three of four patients undergoing initial endovascular embolization experienced re-rupture.
- Open surgery revealed adjacent thrombi with pseudoaneurysm-like cavities at the rupture site.
Conclusions:
- Fragile pseudoaneurysm-like cavities at the rupture point are associated with irregularly shaped aneurysms.
- Endovascular procedures carry a high risk of re-rupture; direct manipulation of fragile areas should be avoided.
- Open surgical clipping may be a safer alternative for certain complex, irregularly shaped aneurysms.