Perforator and secondary branch origin in relation to the neck of saccular, cerebral bifurcation aneurysms

World Neurosurg. 2014 Nov;82(5):726-32. doi: 10.1016/j.wneu.2013.02.052. Epub 2013 Feb 14.

Abstract

Objective: Perforator and secondary branch origin in relation to the neck of cerebral, saccular bifurcation aneurysms were analyzed. These two features were considered important for treatment.

Methods: From a series of microsurgically clipped saccular cerebral aneurysms, 142 bifurcation aneurysms had detailed imaging studies and operative records that could be analyzed.

Results: The incidence of perforator origin from the aneurysm neck was as follows: basilar, 1/15 (7%); internal carotid artery bifurcation, 4/23 (17%); main stem of the middle cerebral artery/secondary branch of the middle cerebral artery, 6/52 (12%); anterior communicating artery region, 5/46 (11%); and distal bifurcation vessels, 0/6 (0%). Aneurysms arising from the anterior communicating artery between the anterior cerebral arteries had a high incidence of perforator origin from the aneurysm neck. The location of secondary branch origin from the aneurysm neck varied depending on the aneurysm group.

Conclusion: Perforator origin from the aneurysm neck was infrequent. A subgroup of anterior communicating artery region aneurysms had a high incidence of perforator origin from the aneurysm neck. Although protection of these neck perforators will be difficult, their identification may be even more challenging. Secondary branch origin from the aneurysm neck varied depending on the aneurysm group. Advanced endovascular techniques are needed to obliterate aneurysms in which the secondary branch(es) arise from the aneurysm neck. If this is not possible, craniotomy and clip ligation will be required if complete aneurysm obliteration is the goal.

Keywords: Aneurysm geometry; Aneurysm treatment; Bifurcation aneurysms; Cerebral saccular aneurysms.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Basilar Artery / diagnostic imaging
  • Basilar Artery / pathology*
  • Basilar Artery / surgery
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Artery, Internal / pathology*
  • Carotid Artery, Internal / surgery
  • Cerebral Angiography
  • Female
  • Humans
  • Intracranial Aneurysm* / diagnostic imaging
  • Intracranial Aneurysm* / pathology
  • Intracranial Aneurysm* / surgery
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / pathology*
  • Middle Cerebral Artery / surgery
  • Neurosurgical Procedures / methods*
  • Surgical Instruments
  • Tomography, X-Ray Computed
  • Young Adult