Fusiform aneurysms: A review from its pathogenesis to treatment options

Abstract

Background: This study aims to present the most important considerations when it comes to patients features, clinical presentation, localization, and morphology of the aneurysm and the treatments outcomes of the fusiform aneurysms.

Methods: We performed a literature review using PubMed. The search was limited to the studies published in English, from 2003 to 2017.

Results: The studies analyzed that showed data about the patient features, clinical presentation, the aneurysm localization, morphology, and pathogenesis didn't present much divergence. The surgical and the endovascular approach showed similar treatments outcomes. The reconstructive techniques seem to be safer than the deconstructive. The flow diversion is a technique that showed great results.

Conclusion: Most of the patients are men, younger than 50 years old, pediatric patients are the most affected. Surgical procedures still have an important place in this field. Reconstructive and deconstructive techniques are both effective; the reconstructive techniques are possibly safer than deconstructive techniques. The most important feature of an aneurysm to predict a bad prognose is to determine if the aneurysm is ruptured. The reconstructive EVT accompanied by dual antiplatelet after and before the procedure showed the best results to treat the basilar fusiform aneurysms. Deconstructive treatment including posterior inferior cerebellar artery occlusion should be considered.

Keywords: Aneurysms; fusiform; intracranial; treatment and basilar.

Figure 1

Model of the fusiform aneurysm pathogenesis. 1: Normal intracranial vessel. 2: Dissection in the internal elastic lamina. 3: Formation of an intramural hematoma. 4: Lipid deposition in and beneath the intima. 5: Disruption of the internal elastic membrane and infiltration to the muscular wall. 6: Intramural hemorrhage. Formation of a hematoma, leading to five main evolution patterns: A – Further expansion of the intramural hematoma. B – Progress enlargement of dissection both laterally and longitudinally. C – Serpentine channel formation. D – Rupture. E – Rupture into the arterial lumen