Relation of the incidence of congenital variations and anomalies with intracranial aneurysms in intracranial arteries

Year 2016, , 515 - 520, 24.12.2016

Yeliz Aktürk , Mehmet Murat Fırat Mehmet Emrah Güven Murat Beyhan

https://doi.org/10.5798/diclemedj.0921.2015.01.0521

Abstract

Objectives: There exists many embryological steps during the development of intracranial vascular structures. Therefore, the congenital variations and anomalies of these structures are often encountered. For a proper evaluation of cerebrovascular imaging studies it is essential to know the frequencies of these anomalies and variations, their locations and the possible accompanying patologies should be distinguished. We aimed to analyse the frequency of congenital variations and anomalies and their association with intracranial aneurysms by evaluating the cerebral angiographic images.
Methods: The cerebral angiograms taken for various reasons in the Radiology Department, Faculty of Medicine, Gaziosmanpasa University, between January 2007 and April 2009, were evaluated in a retrospective fashion. We investigated the association of intracranial aneurysms and congenital variations in addition to the influence of variations on aneurysm formation. A total of 254
cases with intracranial artery variation-anomaly and coexisting intracranial artery aneurysm were included in the study.
Results: The most common variation in intracranial arteries was the agenesis or hypoplasia of the A1 segment of anterior cerebral artery. This was followed infundibular dilatation of posterior communicating artery and fetal type posterior cerebral artery. The incidence of aneurysm was 22.5% in patients who had A1 hypoplasia-agenesia and 18.2% in patients who had trifurcation of middle cerebral artery.
Conclusion: Flow haemodynamics take an important part in the formation of intracranial saccular aneurysms. The incidence of aneurysm formation increases in congenital anomalies of intracranial vascular structures. It is necessary to explore the relationship between variations and aneurysms in order to understand the haemodynamic factors which take place in the pathogenesis of aneurysms. These ratios lead us to think that the incidence of aneurysms increases in cases which have variations when compared to those which have not. 

Keywords

congenital variation, intracranial aneurysm, angiography

İntrakranyal arterlerde konjenital varyasyon ve anomalilerin sıklığı ve intrakranyal anevrizmalar ile birlikteliği

Abstract

Amaç: İntrakranyal vasküler yapıların gelişiminde pek çok embriyolojik basamak bulunur ve konjenital varyasyonları ve anomalileri sık görülür. Serebrovasküler görüntüleme çalışmalarının doğru yorumlanması için bu anomali ve varyasyonların görülme sıklıklarının, lokalizasyonlarının ve eşlik edebilecek patolojilerin ayırdedilebilmesi gereklidir. Çalışmamızda; 2004-2009 yılları arasında yapılmış olan serebral anjiogramları retrospektif olarak değerlendirerek konjenital varyasyon ve anomalilerin sıklığını ve intrakranyal anevrizmalar ile birlikteliğini araştırmayı hedefledik.
Yöntemler: Ocak 2007 ile Nisan 2009 tarihleri arasında Gaziosmanpaşa Üniversitesi Tıp Fakültesi Radyodiagnostik Anabilim Dalı’nda, çeşitli nedenlerle serebral anjiografisi yapılmış olguların arşiv görüntüleri iki radyolog tarafından, birlikte retrospektif olarak incelenmiştir. Toplam 254 olguda intrakraniyal arter varyasyon-anomalileri ve eşlik eden intrakranyal arter anevrizmaları saptanmıştır.
Bulgular: İntrakranyal arterlerde en sık görülen varyasyonlar anterior serebral arter A1 segmentinin hipoplazisi-agenezisi idi. Bunu posterior komünikan arterde infundibülar dilatasyon ve fetal orijinli posterior serebral arter izledi. A1 hipoplazisiagenezisi izlenen olgularda anevrizma görülme oranı %22,5, orta serebral arterde trifürkasyon varyasyonu olan olgularda anevrizma görülme oranı %18,2 idi.
Sonuç: Akım hemodinamiği, intrakranyal sakküler anevrizmaların oluşumunda önemli etkilere sahiptir. İntrakranyal vasküler yapıların konjenital anomalilerinde hemodinamik strese bağlı anevrizma gelişim insidansı artmaktadır. Anevrizmaların patogenezinde yer alan hemodinamik faktörler hakkında bilgi sahibi olmak için varyasyonlar ve anevrizmaların yeri arasındaki ilişkiyi incelemek gerekir. Olgu sayımız sınırlı olmakla birlikte bu oranlar, varyasyonu olmayan hastalar ile karşılaştırıldığında varyasyonlu olgularda anevrizma görülme sıklığının arttığını düşündürmektedir.

Keywords

konjenital varyasyon, intrakranial anevrizma, anjiografi

References

• 1. Gailloud P, Carpenter J, Heck D.V. et al. Pseudofenestration of the cervical internal carotid artery: A pathologic process that simulates an anatomic variant. Am J Neuroradiol 2004;25:421–4.
• 2. Padget DH. The development of the cranial arteries in the human embryo. Contrib Embryol 1948;32:205-262.
• 3. Alpers BJ, Berry RG. Circle of Willis in cerebral vascular disorders. The anatomical structure. Arch Neurol 1963;8:398-402.
• 4. Hassler O. Morphological studies on the large cerebral arteries, with reference to the aetiology of subarachnoid haemorrhage. Acta Psychiatr Scand 1961;154:1-45.
• 5. Rhoton AL Jr. Anatomy of saccular aneurysms. Surg Neurol 1980;14:59-66.
• 6. Karazincir S, Ada E, Sarılmaz A, et al. İntrakranial anevrizmalara eşlik eden vasküler varyasyon ve anomalilerin sıklığı.
• Diagn Interv Radiol 2004;10:103-09.
• 7. Leyon J, Kaliaperumal C, Choudhari K A. Aneurysm at the fenestrated anterior cerebral artery: Surgical anatomy and management. Clin Neurol Neurosurg 2008;110:511–3.
• 8. Oliveira JR, Rochemont RM, Beck J, et al. A rare anomaly of the anterior communicating artery complex hidden by a
• large broadneck aneurysm and disclosed by threedimensional rotational angiography. Acta Neurochir 2008;150:279–84.
• 9. HaceinBey L, Muszynski CA, Varelas PN. Saccular aneurysm associated with posterior cerebral artery fenestration manifesting as a subarachnoid hemorrhage in a child. Am J Neuroradiol 2002;23:1291–94.
• 10. Kayembe KN, Sasahara M, Hazama F. Cerebral aneurysms and variations in the circle of Willis. Stroke 1984;15:846-50.
• 11. Saeki N, Rhoton AL. Microsurgical anatomy of the upper basilaryartery and the posterior circle of Willis. J Neurosurg 1977;46:563-78
• 12. Gast AN, Sluzewski RM. Fenestrations of the anterior communicating artery: Incidence on 3D angiography and relationship to aneurysms. Am J Neuroradiol 2008;29:296 –8.
• 13. Alpers BJ, Berry RG, Paddison RM. Anatomical studies of the circle of Willis in normal brain. AMA Arch Neurol Psychiatry 1959;81:409-18.
• 14. Nathal E, Yasui N, Sampei T, et al. İntraoperative anatomical studies in patients with aneurysm of the anterior communicatin
• g artery complex. J Neurosurg 1992;76:629-34.
• 15. Perlmutter D, Rhoton AL Jr. Microsurgical anatomy of the anterior cerebralanterior communicating recurrent artery complex. J Neurosurg 1976;45:259-72.
• 16. Ujiie H, Liepsch DW, Goetz M, et al. Hemodynamic Study of the Anterior Communicating Artery. Stroke 1996;27:2086-94.
• 17. VanderArk GD, Kempe LC. Classification of anterior communicating aneurysms as a basis for surgical approatlantal arterch. J eurosurg 1970;32:300-03.
• 18. Yaşargil MG, Smith RD, Young PH, et al. Microneuosurgery (II) clinical considerations, srgery of the intracranial aneurysm and results. Vol IV. New York: Thieme, 1984;169-78.
• 19. Wilson G, Riggs H, Rupp C. The pathologic anatomy of ruptured cerebral aneurysm. J Neurosurg 1954;11:128-34.
• 20. Ohno K, Momma S, Suzuki R, et al. Saccular aneurysm of the distal anterior cerebral artery. Neurosurgery 1990;27:907-13.
• 21. Huber P, Braun S, Hirschmann D, et al. Incidence of berry aneurysm o the unpaired pericallosal artery: angiographic study. Neu
• roradiology 1980;19:143-7.
• 22. Bisaria K. Anomalies of the posterior communicating artery and their potential clinical significance. J Neurosurg 1984;60:572-6.
• 23. Saltzman GF. Infundibular widening of the posterior communicating artery studied by carotidangiography. Acta Radiol 1959;51:415-21.
• 24. Kuwahara S, Uga S, Mori K. Successful treatemetne of a ruptured enlarged infundibular widening of the posterior communicatig artery. Neurol Med Chir 2001;41:25-8.
• 25. J.P.P. Peluso, W.J. van Rooij, M. Sluzewski, et al. Aneurysms of the vertebrobasilar junction: Incidence, clinical presentation, and outcome of endovascular treatment. Am J Neuroradiol 2007;28:1747–51.
• 26. Tubbs RS, Hansasuta A, Koukas M, et al. Branches of the petrous and cavernous segments of theinternal carotid artery. Clin Anat 2007;20:596–601.