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Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms
J A Anson1, M T Lawton, R F Spetzler
1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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This study on dolichoectatic and fusiform cerebral aneurysms found surgical treatments effective, with 78% of patients achieving good outcomes. Anterior circulation aneurysms had better results than posterior circulation ones.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Cerebrovascular Diseases
Background:
- Dolichoectatic and fusiform aneurysms are rare, challenging cerebrovascular conditions.
- These aneurysms involve elongated, non-saccular segments of cerebral arteries.
Purpose of the Study:
- To present clinical characteristics and surgical treatments for dolichoectatic and fusiform aneurysms.
- To evaluate treatment outcomes based on aneurysm location (anterior vs. posterior circulation).
Main Methods:
- Retrospective analysis of 40 patients with 41 dolichoectatic or fusiform aneurysms.
- Surgical interventions included clipping, bypass, occlusion, resection, transposition, and wrapping.
- Outcomes assessed using the Glasgow Outcome Scale at late follow-up.
Main Results:
- No surgical mortality was observed.
- Overall good outcomes (Glasgow Outcome Scale 1-2) were achieved in 78% of patients.
- Anterior circulation aneurysms had significantly better outcomes (90% good) than posterior circulation aneurysms (65% good).
Conclusions:
- Surgical management of dolichoectatic and fusiform aneurysms can be effective with low mortality.
- Aneurysm location is a critical factor influencing treatment outcomes.
- These aneurysms may represent a spectrum of a single pathological entity, potentially involving arterial dissection.
Abstract:
Dolichoectatic and fusiform aneurysms represent a small subset of cerebral aneurysms and are often among the most difficult to treat. A consecutive series of 40 patients with 41 of these two types of aneurysms is presented, including their clinical characteristics and surgical treatments. Common to all aneurysms was the pathological involvement of a length of blood vessel with separate inflow and outflow sites (nonsaccular). However, dolichoectatic aneurysms have markedly different symptoms and surgical treatments depending on their location in either the anterior or posterior circulation. Anterior circulation aneurysms involved the petrous internal carotid artery (ICA) in one, the supraclinoid ICA in three, the middle cerebral artery in 13, and the anterior cerebral artery in four patients. Posterior circulation aneurysms involved the basilar artery in 13, the vertebral artery in six, and the posterior inferior cerebellar artery in one patient. Various surgical procedures were performed, including direct clipping, trapping with bypass, proximal occlusion, resection with reanastomosis, transposition, aneurysmorrhaphy with thrombectomy, and wrapping. There was no surgical mortality in the patient series, and treatment was effective in many patients. Overall, outcome at late follow up was good (Glasgow Outcome Scale scores 1-2) in 78% of patients. Patients with anterior circulation aneurysms had better outcomes than patients with posterior circulation aneurysms, with good outcomes in 90% and 65% of the cases, respectively. Dolichoectatic and giant serpentine aneurysms may develop from smaller fusiform aneurysms and represent a spectrum of the same pathological entity. Arterial dissection may also play a role in the initial development of these aneurysms.