gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Hemodynamic stress on the development of distal intracranial aneurysms

Meeting Abstract

  • H. Tokimura - Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan
  • S. Sugata - Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan
  • H. Yamahata - Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan
  • K. Hirahara - Kagoshima City Hospital, Division of Neurosurgery, Kagoshima City, Japan
  • K. Uetsuhara - Kagoshima City Hospital, Division of Neurosurgery, Kagoshima City, Japan
  • K. Takasaki - Atsuchi Neurosurgical Hospital, Atsuchi, Japan
  • M. Atsuchi - Atsuchi Neurosurgical Hospital, Atsuchi, Japan
  • K. Arita - Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.06.08

DOI: 10.3205/12dgnc210, URN: urn:nbn:de:0183-12dgnc2107

Published: June 4, 2012

© 2012 Tokimura et al.
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Outline

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Objective: Aneurysms located at the distal portion of the cerebral or cerebellar arteries are relatively rare. We retrospectively investigated the anatomical features of distal aneurysms and surrounding arteries. We specifically focused on variations in the circle of Willis that affect the hemodynamic status as factors contributing to the development of distal aneurysms.

Methods: From 2000 to 2011, 4112 cases with intracranial aneurysms were treated in our hospitals group. Among them, 110 cases with 117 distal aneurysms were reviewed. In this study, we investigated the aneurysms at the distal part of anterior cerebral artery (ACA), posterior cerebral artery (PCA), anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (PICA). The diagnostic imaging protocol included contrast-enhanced three-dimensional CT angiography (3D-CTA), magnetic resonance- (MRA) and cerebral catheter angiography (DSA).

Results: Our series includes 76 women and 34 men. The averaged age was 59.4. Of the 117 aneurysms 76 were ruptured and 41 were unruptured.

distal ACA: 45 aneurysms (76%) out of 59 aneurysms were located at the anterior A3 segment of ACA. 9 cases (16%) had anomalies of ACA. Defect or hypoplasia of posterior communicating artery (p-com) were recognized in 35 cases (76.1%) of 46 cases without ACA anomalies

distal PCA: 7 aneurysms (38.9%) out of 18 aneurysms were located at P2-P3 portion of PCA. Ipsilateral fetal p-com arteries were recognized in 6 cases (40%) out of 15 cases. Ipsilateral P1 dominancy was seen in 8 cases (53.3%) of 15 cases.

distal AICA: 5 aneurysms (55.6%) out of 9 aneurysms were located at meatal segment of AICA. Absence of ipsilateral PICA was seen in 5 cases (55.6%) of 9 cases.

distal PICA: 22 aneurysms (73.3%) out of 30 aneurysms were located at lateral medullary- (n = 9), tonsillomedullary- (n = 7), and telovelotonsillary (n = 6) segments of PICA. Absence of contralateral PICA (n = 8), absence of ipsilateral AICA (n = 8), and hyoplasia of vertebral artery (n = 6) were recognized.

Conclusions: Aneurysms originated at the distal portion of the cerebral or cerebellar arteries were commonly seen not at their bifurcation sites. In our series of distal aneurysms, normal variations in the circle of Willis thought to increase the hemodynamic status to the target arteries. This hemodynamic stress played an important role on the development of distal aneurysms.