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Middle Cerebral Artery Bifurcation Aneurysm: Wall Enhancement in MRI Vessel Wall Imaging Correlates with Histological Findings

  • Charlotte FlühEmail author
  • Naomi Larsen
  • Michael Synowitz
Living reference work entry

Abstract

Here we present the case of a 57-year-old female patient with an unruptured, broad-necked 10 × 8 mm left MCA bifurcation aneurysm, which was clipped via a left pterional approach. The clipping procedure was performed in conjunction with intraoperative indocyanine green (ICG) angiography, and postoperative DSA was performed. Prior to the procedure, the patient underwent MRI vessel wall imaging, which showed significant contrast enhancement of the aneurysm sac, in addition to standard cranial MRI and DSA. The operation was performed without complication, and the postoperative course was uneventful. Histopathological analysis of the aneurysm sac revealed features of inflammation and neovascularization. The correlation of vessel wall imaging and histological findings is the main topic of this chapter.

Keywords

Middle cerebral artery bifurcation Microsurgical clipping MRI vessel wall imaging 

References

  1. Darkwah Oppong M, Pierscianek D, Ahmadipour Y, Dinger TF, Dammann P, Wrede KH, Özkan N, Müller O, Sure U, Jabbarli R. Intraoperative aneurysm rupture during microsurgical clipping: risk re-evaluation in the post-International Subarachnoid Aneurysm Trial era. World Neurosurg. 2018;119:e349–56.  https://doi.org/10.1016/j.wneu.2018.07.158.CrossRefPubMedGoogle Scholar
  2. Edjlali M, Gentric JC, Régent-Rodriguez C, Trystram D, Hassen WB, Lion S, Nataf F, Raymond J, Wieben O, Turski P, Meder JF, Oppenheim C, Naggara O. Does aneurysmal wall enhancement on vessel wall MRI help to distinguish stable from unstable intracranial aneurysms? Stroke. 2014;45(12):3704–6.  https://doi.org/10.1161/STROKEAHA.114.006626.CrossRefPubMedGoogle Scholar
  3. Gounis MJ, Vedantham S, Weaver JP, Puri AS, Brooks CS, Wakhloo AK, Bogdanov AA Jr. Myeloperoxidase in human intracranial aneurysms: preliminary evidence. Stroke. 2014;45(5):1474–7.  https://doi.org/10.1161/STROKEAHA.114.004956.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Gounis MJ, van der Marel K, Marosfoi M, Mazzanti ML, Clarençon F, Chueh JY, Puri AS, Bogdanov AA Jr. Imaging inflammation in cerebrovascular disease. Stroke. 2015;46(10):2991–7.  https://doi.org/10.1161/STROKEAHA.115.008229.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Hoh BL, Hosaka K, Downes DP, Nowicki KW, Wilmer EN, Velat GJ, Scott EW. Stromal cell-derived factor-1 promoted angiogenesis and inflammatory cell infiltration in aneurysm walls. J Neurosurg. 2014;120(1):73–86.  https://doi.org/10.3171/2013.9.JNS122074.CrossRefPubMedGoogle Scholar
  6. Hu P, Yang Q, Wang DD, Guan SC, Zhang HQ. Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology. 2016;58(10):979–85.  https://doi.org/10.1007/s00234-016-1729-3.CrossRefPubMedGoogle Scholar
  7. Larsen N, von der Brelie C, Trick D, Riedel CH, Lindner T, Madjidyar J, Jansen O, Synowitz M, Flüh C. Vessel wall enhancement in unruptured intracranial aneurysms: an indicator for higher risk of rupture? High-resolution MR imaging and correlated histologic findings. AJNR Am J Neuroradiol. 2018;39(9):1617–21.  https://doi.org/10.3174/ajnr.A5731.CrossRefPubMedGoogle Scholar
  8. Maiellaro K, Taylor WR. The role of the adventitia in vascular inflammation. Cardiovasc Res. 2007;75(4):640–8.  https://doi.org/10.1016/j.cardiores.2007.06.023.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Matouk CC, Mandell DM, Günel M, Bulsara KR, Malhotra A, Hebert R, Johnson MH, Mikulis DJ, Minja FJ. Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle. Neurosurgery. 2013;72(3):492–6; discussion 496.  https://doi.org/10.1227/NEU.0b013e31827d1012.CrossRefPubMedGoogle Scholar
  10. Nagahata S, Nagahata M, Obara M, Kondo R, Minagawa N, Sato S, Sato S, Mouri W, Saito S, Kayama T. Wall enhancement of the intracranial aneurysms revealed by magnetic resonance vessel wall imaging using three-dimensional turbo spin-echo sequence with motion-sensitized driven-equilibrium: a sign of ruptured aneurysm? Clin Neuroradiol. 2016;26(3):277–83.  https://doi.org/10.1007/s00062-014-0353-z.CrossRefPubMedGoogle Scholar
  11. Ollikainen E, Tulamo R, Frösen J, Lehti S, Honkanen P, Hernesniemi J, Niemelä M, Kovanen PT. Mast cells, neovascularization, and microhemorrhages are associated with saccular intracranial artery aneurysm wall remodeling. J Neuropathol Exp Neurol. 2014;73(9):855–64.  https://doi.org/10.1097/NEN.0000000000000105.CrossRefPubMedGoogle Scholar
  12. Portanova A, Hakakian N, Mikulis DJ, Virmani R, Abdalla WM, Wasserman BA. Intracranial vasa vasorum: insights and implications for imaging. Radiology. 2013;267(3):667–79.  https://doi.org/10.1148/radiol.13112310.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Charlotte Flüh
    • 1
    Email author
  • Naomi Larsen
    • 1
  • Michael Synowitz
    • 1
  1. 1.Klinik für NeurochirurgieUniversitätsklinikum Schleswig-Holstein, Campus KielKielGermany

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