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(Stroke. 2000;31:896.)
© 2000 American Heart Association, Inc.

Original Contributions

Clinicopathological Study of Intracranial Fusiform and Dolichoectatic Aneurysms

Insight on the Mechanism of Growth

Hirofumi Nakatomi, MD; Hiromu Segawa, MD; Atsushi Kurata, MD; Yoshiaki Shiokawa, MD; Kazuya Nagata, MD; Hiroyasu Kamiyama, MD; Keisuke Ueki, MD Takaaki Kirino, MD

From the Department of Neurosurgery (H.N., K.U., T.K.) and Department of Pathology (A.K.), Tokyo University School of Medicine, Tokyo; the Fuji Brain Institute (H.S., Y.S.), Shizuoka; the Showa General Hospital (K.N.), Kodaira; and Asahikawa Redcross Hospital (H.K.), Asahikawa, Japan.

Correspondence and reprint requests to Hirofumi Nakatomi, MD, Department of Neurosurgery, Tokyo University School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8635, Japan. E-mail: hnakatomi-tky{at}umin.ac.jp

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 (IEL), (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 IEL 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.

Key Words: aneurysm, dolichoectatic • aneurysm, fusiform • aneurysm, giant • growth substances

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