Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms - Insight on the mechanism of growth
Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms - Insight on the mechanism of growth
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DOI：
10.1161/01.str.31.4.896
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发表时间：
2000-04-01
期刊：
影响因子：
8.3
通讯作者：
Kirino, T
中科院分区：
文献类型：
--
作者：
Nakatomi, H;Segawa, H;Kirino, T
背景和目的-颅内梭形动脉瘤在临床上可分为两种不同的亚型：急性夹层动脉瘤和慢性梭形或长扩张动脉瘤。这2个，慢性梭形动脉瘤的自然历史和生长机制仍然unknow.Methods-A连续系列的16例慢性梭形动脉瘤进行了回顾性研究，以澄清患者的临床和神经放射学特征。从8例中获得动脉瘤组织，并进行检查，以确定组织学特征，可以对应于放射学findings.Results-Four组织学特征被发现：（1）内弹性膜（TEL）断裂，（2）增厚内膜内的新血管生成，（3）壁内出血（IMH）和血栓形成，（4）血栓内新生血管的重复性壁内扩张。所有病例均发现IEL碎裂，这表明这种变化可能是动脉瘤形成的最早过程之一。MRI或CT检测到IMH，MRI上动脉瘤壁内部（CEI）明显对比增强：与内膜增厚良好对应。8 9例有症状的情况下，但没有7例无症状的情况下，提出了这两个放射学features. Conclusions数据表明，慢性梭形动脉瘤是渐进性病变，开始与TEL碎片。IMH的形成似乎是病变出现症状和进展所必需的关键事件，这可以通过MRI进行监测。了解这种可能的进展机制和相应的MRI特征有助于确定手术干预的时机。
Background and Purpose-Intracranial fusiform aneurysms can be divided into 2 clinically different subtypes: acute dissecting aneurysms and chronic fusiform or dolichoectatic aneurysms. Of these 2, the natural history and growth mechanism of chronic fusiform aneurysms remains unknown.Methods-A consecutive series of 16 patients with chronic fusiform aneurysms was studied retrospectively to clarify patient clinical and neuroradiological features. Aneurysm tissues were obtained from 8 cases and were examined to identify histological features that could correspond to the radiological findings.Results-Four histological features were found: (1) fragmentation of internal elastic lamina (TEL), (2) neoangiogenesis within the thickened intima, (3) intramural hemorrhage (IMH) and thrombus formation, and (4) repetitive intramural hemorrhages from the newly formed vessels within thrombus. IEL fragmentation was found in all cases, which suggests that this change may be one of the earliest processes of aneurysm formation. MRI or CT detected IMH, and marked contrast enhancement of the inside of the aneurysm wall (CEI) on MRI: corresponded well with intimal thickening. Eight of 9 symptomatic cases but none of 7 asymptomatic cases presented with both radiological features.Conclusions-Data suggest that chronic fusiform aneurysms are progressive lesions that start with TEL fragmentation. Formation of IMH seems to be a critical event necessary for lesions to become symptomatic and progress, and this can be monitored on MRI. Knowledge of this possible mechanism of progression and corresponding MRI characteristics could help determine timing of surgical intervention.