Surgical Treatment of Thrombosed Giant Aneurysms in the Posterior Fossa

Giant fusiform aneurysms are characterized by tortuosity, elongation, distention, and partial thrombosis, and are most frequently found in the vertebrobasilar circulation. Surgical removal of these aneurysms is the treatment of choice for such lesions because they often develop mass signs. We report 14 surgically treated cases that were classified into so-called thrombosed aneurysms in the posterior fossa (VA involved: 9, VA-BA involved: 3, BA involved: 2). Four cases out of 9 VAinvolved cases were treated with aneurysmal trapping and aneurysmectomy after OA-PICA anastomosis. The other 5 cases were trapped and aneurysmectomy was performed because of no involvement of PICA flow. Seven out of 9 cases showed very excellent surgical outcomes instead of preoperative pyramidal signs. However, 5 cases involving VA-BA or BA were treated with high flow bypass (VA-RA-PCA bypass), and Hunterian ligation showed very poor surgical outcomes. Only 1 case recovered well after surgery and resumed social activity. The unsatisfactory results were considered to be caused by high flow bypass flew up thrombus induced within the blind aneurysm sac into the perforators, resulting in catastrophic central pontine infarction. The enhanced reversed flow through the bypass caused the already thrombosed aneurysms to grow. We analyze the operative results and discuss the pathogenesis.

[1]  弘裕 氏家,et al.  Dolichoectatic basilar aneurysmの自然予後および現在の治療状況 , 2004 .

[2]  K. Nagata,et al.  Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms : insight on the mechanism of growth. , 2000, Stroke.

[3]  S. Kuroda,et al.  Long-term patency of radial artery graft bypass for reconstruction of the internal carotid artery. Technical note. , 1999, Journal of neurosurgery.

[4]  K. Kansaku,et al.  Serial magnetic resonance imaging of acute spontaneous thrombosis of a giant intracranial aneurysm--case report. , 1998, Neurologia medico-chirurgica.

[5]  T. Takizawa,et al.  Giant unruptured aneurysm of the vertebral artery presenting with rapidly progressing bulbar compression--case report. , 1997, Neurologia medico-chirurgica.

[6]  S. Endo,et al.  Non-aneurysmal subarachnoid hemorrhage associated with basilar artery dissection--autopsy case report. , 1997, Neurologia medico-chirurgica.

[7]  S. Peerless,et al.  Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. , 1997, Journal of neurosurgery.

[8]  S. Koyama,et al.  Giant basilar artery aneurysm with intramural hemorrhage and then disastrous hemorrhage: case report. , 1996, Neurosurgery.

[9]  T. Mizutani.  A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. , 1996, Journal of neurosurgery.

[10]  R F Spetzler,et al.  Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. , 1996, Journal of neurosurgery.

[11]  Y. Kai,et al.  Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. , 1995, Journal of neurosurgery.

[12]  H. Kamiyama.  [Bypass with radial artery graft]. , 1994, No shinkei geka. Neurological surgery.

[13]  A. Isla,et al.  Serpentine aneurysm: regrowth after a superficial temporal artery-middle cerebral artery bypass and internal carotid artery ligation: case report. , 1994, Neurosurgery.

[14]  S. Endo,et al.  A Pathological Study of Intracranial Posterior Circulation Dissecting Aneurysms with Subarachnoid Hemorrhage , 1993 .

[15]  S. Endo,et al.  A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature. , 1993, Neurosurgery.

[16]  Y. Katayama,et al.  Growth of totally thrombosed giant aneurysm within the posterior cranial fossa , 1991, Neuroradiology.

[17]  H. Vinters,et al.  Fusiform intracranial aneurysms. Clinicopathologic features. , 1988, Surgical neurology.

[18]  N. Tamaki,et al.  Dolichoectatic basilar artery: a review of 23 cases. , 1986, Stroke.

[19]  T. Sundt,et al.  Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease. , 1986, Journal of neurosurgery.

[20]  W. Stehbens.  Experimental arterial loops and arterial atrophy. , 1986, Experimental and molecular pathology.

[21]  C. Delcour,et al.  Giant fusiform aneurysm of the basilar artery. Clinico-pathological report of 3 cases. , 1984, Acta Neurologica Belgica.

[22]  M. R. Roach,et al.  An Experimental Study of the Production and Time Course of Poststenotic Dilatation in the Femoral and Carotid Arteries of Adult Dogs , 1963, Circulation research.

[23]  氏家弘.  How I Do It 2-Dolichoectatic giant aneurysm of the basilar artery , 2003 .

[24]  H. Kamiyama,et al.  Reconstruction of the Basilar Arterial System , 1999 .

[25]  H. Kamiyama,et al.  Reconstruction of the Basilar Arterial System:Methods of High Flow Bypass in Posterior Cranial Fossa , 1999 .

[26]  C. Drake.  Giant intracranial aneurysms: experience with surgical treatment in 174 patients. , 1979, Clinical neurosurgery.

[27]  H. Barr,et al.  Giant intracranial aneurysms: diagnosis, course, and management. , 1969, Clinical neurosurgery.