Characteristics of Blood Blister-Like Aneurysms with a Saccular-Shape Appearance
Characteristics of Blood Blister-Like Aneurysms with a Saccular-Shape Appearance
复制标题
DOI：
10.1016/j.wneu.2017.09.054
复制
发表时间：
2017-12-01
影响因子：
2
通讯作者：
Suzuki, Hidenori
中科院分区：
文献类型：
--
作者：
Nishikawa, Hirofumi;Shimizu, Shigetoshi;Suzuki, Hidenori
背景：血泡样动脉瘤（BBA）是位于颈内动脉（ICA）非分支部位的动脉瘤的一个亚组，其特点是体积小、壁脆弱和边界不清、宽基颈。 BBA 的直接手术和血管内治疗通常都具有挑战性。据报道，一些 BBA 看起来像真正的囊状动脉瘤，BBA 的误诊可能会导致灾难性的后果。本研究的目的是阐明囊状 BBA 的临床和术中表现。方法：我们分析了连续 11 例因 BBA 破裂导致蛛网膜下腔出血的患者的临床和术中表现。 BBA分为典型BBA和囊状BBA，典型BBA被定义为典型的微小、广泛的、水泡状动脉瘤，而囊状BBA看起来像真正的囊状动脉瘤，但术中发现ICA裂伤证明是BBA。分析囊状BBA的特点。结果：有4例囊状BBA患者，其入院日期从发病当天到发病后数日不等。囊状 BBA 的起源是 ICA 的内壁 (n = 2) 或前壁 (n = 2)。 4个囊状BBA中有3个指向视神经，而典型BBA中没有一个指向视神经。结论：囊状BBA可能不仅是典型BBA继发发展的，而且是当动脉瘤指向视神经时通过周围结构依赖机制形成的。本研究的结果表明，位于 ICA 朝向视神经的非分支部位的囊状动脉瘤应被视为囊状 BBA。
BACKGROUND: Blood blister-like aneurysms (BBAs) are a subgroup of aneurysms located on nonbranching sites of the internal carotid artery (ICA) and characterized by small size, a fragile wall, and a poorly defined broad-based neck. Both direct surgery and endovascular treatment for BBAs are often challenging. Some of the BBAs have been reported to look like true saccular aneurysms, and the misdiagnosis of BBA might result in catastrophic outcomes. The purpose of this study is to clarify the clinical and intraoperative findings of saccular BBAs.METHODS: We analyzed clinical and intraoperative findings in consecutive 11 patients with subarachnoid hemorrhage caused by ruptured BBA. BBAs were divided into typical BBAs, which were defined as typical tiny, broad-based, blister-like aneurysms, and saccular BBAs, which seemingly looked like true saccular aneurysms but were demonstrated to be BBAs by the intraoperative findings of the laceration of the ICA. The characteristics of saccular BBAs were analyzed.RESULTS: There were 4 patients with saccular BBAs in which the admission day was diverse from the onset day to several days after the onset. The origin of saccular BBAs was the medial (n = 2) or anterior (n = 2) walls of the ICA. Three of the 4 saccular BBAs pointed toward the optic nerve, whereas none of the typical BBAs pointed toward the optic nerve.CONCLUSIONS: Saccular BBAs may not merely develop secondarily from typical BBAs, but also form by the surrounding structures-dependent mechanisms when an aneurysm points toward the optic nerve. The findings in this study suggest that saccular-shaped aneurysms at nonbranching sites of the ICA toward the optic nerve should be considered as saccular BBAs.