Journal of neurosurgery
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Journal of neurosurgery · Jul 2013
Pathomorphometry of ruptured intracranial vertebral arterial dissection: adventitial rupture, dilated lesion, intimal tear, and medial defect.
Subarachnoid hemorrhage (SAH) due to ruptured intracranial vertebral artery (VA) dissection is a life-threatening disease. Angiographic and symptomatic prognostic factors for rupture and rerupture have been investigated, but the pathological characteristics have not been fully investigated. The authors aimed to investigate these features by performing a pathomorphometic study of ruptured intracranial VA dissections. ⋯ Every ruptured intracranial VA dissection has a single point of adventitial rupture where the adventitia was maximally extended, so dilation appears to be a valuable predictive factor for hemorrhagic intracranial VA dissections. The adventitial ruptures were as small as 2 mm in length, and clinically detectable dilated lesions were about 9 mm in length. However, vascular vulnerability caused by IEL ruptures and medial defects existed more widely across a length of VA of 1.3-1.5 cm. Comparatively broader protection of the intracranial VA than the clinically detected area of dissection might be desirable to prevent rebleeding. Broader protection of proximal lesions than distal lesions might be effective from the viewpoint of site distribution of vascular lesions and blood flow alteration to the pseudolumen caused by the dissecting hematoma. Medial defects are the most widely seen lesions among the 4 types of vascular lesions studied. Medial degenerative disease, known as segmental arterial mediolysis, is suspected in the pathogenesis of intracranial VA dissections.
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Journal of neurosurgery · Jul 2013
Case ReportsInfundibular widening mimicking anterior communicating artery aneurysm: report of 2 cases.
Because infundibular widening most commonly appears at the origins of the posterior communicating artery and anterior choroidal artery from the internal carotid artery, its occurrence in association with the anterior communicating artery (ACoA) or the A1-A2 junction can be misinterpreted as an ACoA aneurysm on angiograms. The authors report on 2 such cases; one in a 73-year-old woman with infundibular widening of the recurrent artery of Heubner, and the other in a 44-year-old woman with infundibular widening of a perforating vessel from the ACoA. The correct diagnosis was established based on surgical exploration. In addition, grayscale modification of 3D reconstruction images of preoperative digital subtraction angiography revealed the cases of the recurrent artery of Heubner and perforating artery of the ACoA arising from the apex of the infundibular widening.