Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Are Blood Blister-Like Aneurysms a Specific Type of Dissection? A Comparative Study of Blood Blister-Like Aneurysms and Ruptured Mizutani Type 4 Vertebral Artery Dissections

  • Sim, Sook Young (Department of Neurosurgery, Inje University Seoul Paik Hospital) ;
  • Chung, Joonho (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Shin, Yong Sam (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2013.08.05
  • Accepted : 2014.07.04
  • Published : 2014.11.28
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Abstract

Objective : Blood blister-like aneurysms (BBAs) resemble arterial dissections. The purpose of this study was to investigate the relationship between these two disease entities and highlight commonalities and distinct features. Methods : Among 871 consecutive patients with aneurysmal subarachnoid hemorrhage, 11 BBAs of internal carotid artery and seven vertebral artery dissections (VADs) with a short segmental eccentric dilatation (Mizutani type 4), which is morphologically similar to a BBA, were selected. The following clinical factors were studied in each group : age, gender, risk factors, Hunt and Hess grade (HHG), Fisher grade (FG), vasospasms, hydrocephalus, perioperative rebleeding rate, and treatment outcome. Results : The mean age was 47.9 years in the BBAs group and 46.4 years in the type 4 VADs group. All the BBA patients were female, whereas there was a slight male predominance in the type 4 VAD group (male : female ratio of 4 : 3). In the BBA and type 4 VAD groups that underwent less aggressive treatment to save the parent artery, 29% (n=2/7) and 66.6% (n=2/3), respectively, eventually required retreatment. Perioperative rebleeding occurred in 72.7% (n=8) and 28.6% (n=2) of patients in the BBA and type 4 VAD groups, respectively. There was no statistical difference in the other clinical factors in both groups, except for the male dominancy in the type 4 VAD group (p=0.011). Conclusion : BBAs and ruptured type 4 VADs have a similar morphological appearance but there is a distinct clinical feature in gender and perioperative rebleeding rates. Complete isolation of an aneurysm from the parent artery might be the most important discipline for the treatment of these diseases.

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References

  1. Abe M, Tabuchi K, Yokoyama H, Uchino A : Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89 : 419-424, 1998 https://doi.org/10.3171/jns.1998.89.3.0419
  2. Anxionnat R, de Melo Neto JF, Bracard S, Lacour JC, Pinelli C, Civit T, et al. : Treatment of hemorrhagic intracranial dissections. Neurosurgery 62 (6 Suppl 3) : 1525-1531, 2008
  3. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. : Vertebral artery dissection : presenting findings and predictors of outcome. Stroke 37 : 2499-2503, 2006 https://doi.org/10.1161/01.STR.0000240493.88473.39
  4. Day AL, Gaposchkin CG, Yu CJ, Rivet DJ, Dacey RG Jr : Spontaneous fusiform middle cerebral artery aneurysms : characteristics and a proposed mechanism of formation. J Neurosurg 99 : 228-240, 2003 https://doi.org/10.3171/jns.2003.99.2.0228
  5. de Bray JM, Penisson-Besnier I, Dubas F, Emile J : Extracranial and intracranial vertebrobasilar dissections : diagnosis and prognosis. J Neurol Neurosurg Psychiatry 63 : 46-51, 1997 https://doi.org/10.1136/jnnp.63.1.46
  6. Fisher CM, Kistler JP, Davis JM : Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6 : 1-9, 1980 https://doi.org/10.1227/00006123-198001000-00001
  7. Friedman AH, Drake CG : Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60 : 325-334, 1984 https://doi.org/10.3171/jns.1984.60.2.0325
  8. Hamada Y, Mannoji H, Kaneko Y : A ruptured dissecting aneurysm of the vertebral artery : comparison of angiographic and histological findings. Neuroradiology 43 : 375-378, 2001 https://doi.org/10.1007/s002340000339
  9. Hunt WE, Hess RM : Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28 : 14-20, 1968 https://doi.org/10.3171/jns.1968.28.1.0014
  10. Ishikawa T, Nakamura N, Houkin K, Nomura M : Pathological consideration of a "blister-like" aneurysm at the superior wall of the internal carotid artery : case report. Neurosurgery 40 : 403-405; discussion 405-406, 1997 https://doi.org/10.1097/00006123-199702000-00038
  11. Jennett B, Bond M : Assessment of outcome after severe brain damage. Lancet 1 : 480-484, 1975
  12. Mizutani T, Miki Y, Kojima H, Suzuki H : Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45 : 253-259; discussion 259-260, 1999 https://doi.org/10.1097/00006123-199908000-00010
  13. Mokri B, Houser OW, Sandok BA, Piepgras DG : Spontaneous dissections of the vertebral arteries. Neurology 38 : 880-885, 1988 https://doi.org/10.1212/WNL.38.6.880
  14. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366 : 809-817, 2005 https://doi.org/10.1016/S0140-6736(05)67214-5
  15. Nakagawa F, Kobayashi S, Takemae T, Sugita K : Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 65 : 303-308, 1986 https://doi.org/10.3171/jns.1986.65.3.0303
  16. Ogawa A, Suzuki M, Ogasawara K : Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery : internal carotid artery trunk aneurysms. Neurosurgery 47 : 578-583; discussion 583-586, 2000
  17. Park SI, Kim BM, Kim DI, Shin YS, Suh SH, Chung EC, et al. : Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 30 : 1351-1356, 2009 https://doi.org/10.3174/ajnr.A1561
  18. Ro A, Kageyama N, Abe N, Takatsu A, Fukunaga T : Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage : clinical and histopathological investigations from a medicolegal perspective. J Neurosurg 110 : 948-954, 2009 https://doi.org/10.3171/2008.11.JNS08951
  19. Satoh A, Nakamura H, Odaki M, Kobayashi S, Kageyama Y, Fukuda K, et al. : High risk aneurysms of the internal carotid artery : dorsal IC aneurysm. Surg Cereb Stroke 21 : 467-472, 1993 https://doi.org/10.2335/scs1987.21.6_467
  20. Shigeta H, Kyoshima K, Nakagawa F, Kobayashi S : Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta Neurochir (Wien) 119 : 42-48, 1992 https://doi.org/10.1007/BF01541780
  21. Shin JH, Suh DC, Choi CG, Leei HK : Vertebral artery dissection : spectrum of imaging findings with emphasis on angiography and correlation with clinical presentation. Radiographics 20 : 1687-1696, 2000 https://doi.org/10.1148/radiographics.20.6.g00nv081687
  22. Sim SY, Shin YS, Cho KG, Kim SY, Kim SH, Ahn YH, et al. : Blood blister-like aneurysms at nonbranching sites of the internal carotid artery. J Neurosurg 105 : 400-405, 2006 https://doi.org/10.3171/jns.2006.105.3.400
  23. Yamaura A, Watanabe Y, Saeki N : Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72 : 183-188, 1990 https://doi.org/10.3171/jns.1990.72.2.0183
  24. Yoon SM, Shim JJ, Kim SH, Chang JC : Bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage treated by staged coil trapping and covered stents graft. J Korean Neurosurg Soc 51 : 155-159, 2012 https://doi.org/10.3340/jkns.2012.51.3.155

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