Discrepancy between preoperative imaging and postoperative pathological finding of ruptured intracranial dissecting aneurysm, and its surgical treatment: case report

Neurol Med Chir (Tokyo). 2014;54(3):219-26. doi: 10.2176/nmc.cr2012-0433. Epub 2013 Nov 8.

Abstract

The choice of therapeutic strategy for intracranial dissecting aneurysm is often based on radiographic features, including characteristic geometry (e.g., irregular stenosis, segmental stenosis, aneurysm formation [pearl-and-string sign]), irregular fusiform or aneurysmal dilation, double lumen, and tapering occlusion. However, there is often a discrepancy between preoperative radiographic data and actual dissecting length. The present report describes three cases in which there was a discrepancy between preoperative radiographic data and actual dissecting length in patients undergoing direct trapping with or without revascularization. All three cases experienced good outcomes, but these cases underscore the fact that open surgery is a good option for management of ruptured intracranial dissecting aneurysms for determination of the rupture point, dissecting length, and the relationship between dissecting area and small arteries arising from the associated vessel.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aneurysm, Ruptured / diagnosis*
  • Aneurysm, Ruptured / pathology
  • Aneurysm, Ruptured / surgery*
  • Aortic Dissection / diagnosis*
  • Aortic Dissection / pathology
  • Aortic Dissection / surgery*
  • Carotid Artery Diseases / pathology
  • Carotid Artery Diseases / surgery
  • Carotid Artery, Internal / pathology
  • Carotid Artery, Internal / surgery
  • Cerebellum / blood supply
  • Cerebral Angiography*
  • Craniotomy
  • Diagnostic Errors*
  • Female
  • Humans
  • Imaging, Three-Dimensional*
  • Intracranial Aneurysm / diagnosis*
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / pathology
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / pathology
  • Subarachnoid Hemorrhage / surgery
  • Tomography, X-Ray Computed*
  • Vertebral Artery / pathology
  • Vertebral Artery / surgery