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Characteristics and Clinical Course of Fusiform Middle Cerebral Artery Aneurysms According to Location, Size, and Configuration

Journal of Korean Neurosurgical Society 2019년 62권 6호 p.649 ~ 660
Seo Dong-Wook, 이시운, 오창완, 권오기, Ban Seung-Pil, Kim Tack-Eun, 변형수, 김영덕, 이용재, Won Yu-Deok, 방재승,
소속 상세정보
 ( Seo Dong-Wook ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
이시운 ( Lee Si-Un ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
오창완 ( Oh Chang-Wan ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
권오기 ( Kwon O-Ki ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
 ( Ban Seung-Pil ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
 ( Kim Tack-Eun ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
변형수 ( Byoun Hyoung-Soo ) - Chungnam National University Hospital Department of Neurosurgery
김영덕 ( Kim Young-Deok ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
이용재 ( Lee Yong-Jae ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
 ( Won Yu-Deok ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
방재승 ( Bang Jae-Seung ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery

Abstract


Objective: To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration.

Methods: We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm).

Results: The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1.

Conclusion: While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.

키워드

Aneurysm, Dissecting; Fusiform aneurysm; Middle cerebral artery; Natural history

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