Немешотчатые аневризмы: патогенез, клиника, методы лечения (обзор литературы)
https://doi.org/10.17650/1683-3295-2020-22-3-76-83
Аннотация
При выявлении локального расширения артерии неоправданно часто применяется термин «фузиформная аневризма». Однако под этим термином скрывается гетерогенная группа патологий артерий, и точная их диагностика важна для определения прогноза и выбора лечебной тактики. Проведен анализ 63 зарубежных и 4 отечественных научных источников, опубликованных в 1987–2019 гг. и посвященных различным аспектам патогенеза немешотчатых аневризм и эффективности методов их лечения. Среди немешотчатых аневризм выделяют долихоэктатические, возникновение которых обусловлено генетическими или неатеросклеротическими факторами, и фузиформные, возникающие вследствие процесса расслоения стенок артерий. Описаны механизмы их формирования, варианты клинического течения и методы лечения.
Ключевые слова
Об авторах
Л. Я. Кравец
ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава России
Россия
Россия
Леонид Яковлевич Кравец
603950 Нижний Новгород, пл. Минина и Пожарского, 10/1
А. Д. Погосян
ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава России
Россия
Россия
603950 Нижний Новгород, пл. Минина и Пожарского, 10/1
Список литературы
1. Park S.-H., Yim M.-B., Lee C.-Y. et al. Intracranial fusiform aneurysms: it’s pathogenesis, clinical characteristics and managements. J Korean Neurosurg Soc 2008;44(3):116–23. DOI: 10.3340/jkns.2008.44.3.116.
2. Nakatomi H., Segawa H., Kurata A. et al. Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 2000;31(4):896–900. DOI: 10.1161/01.str.31.4.896.
3. Findlay J.M., Hao C., Emery D. Non-atherosclerotic fusiform cerebral aneurysms. Can J Neurol Sci 2002;29(1): 41–8. DOI: 10.1017/s0317167100001700.
4. Gross B.A., Smith E.R., Scott R.M., Orbach D.B. Intracranial aneurysms in the youngest patients: characteristics and treatment challenges. Pediatr Neurosurg 2015;50(1):18–25. DOI: 10.1159/000370161.
5. Anson J.A., Lawton M.T., Spetzler R.F. Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 1996;84(2):185–93. DOI: 10.3171/jns.1996.84.2.0185.
6. Resta M., Gentile M.A., Di Cuonzo F. et al. Clinical-angiographic correlations in 132 patients with megadolichovertebrobasilar anomaly. Neuroradiology 1984;26(3):213–6. DOI: 10.1007/BF00342416.
7. Ota N., Tanikawa R., Kamiyama H. et al. Discrepancy between preoperative imaging and postoperative pathological finding of ruptured intracranial dissecting aneurysm, and its surgical treatment: case report. Neurol Med Chir (Tokyo) 2014;54(3):219–26. DOI: 10.2176/nmc.cr2012-0433.
8. Caplan L.R. Dilatative arteriopathy (dolichoectasia): what is known and not known. Ann Neurol 2005;57(4):469–71. DOI:10.1002/ana.20447.
9. Lou M., Caplan L.R. Vertebrobasilar dilatative arteriopathy (dolichoectasia). Ann N Y Acad Sci 2010;1184(1):121–33. DOI: 10.1111/j.1749-6632.2009.05114.x.
10. Flemming K.D., Wiebers D.O., Brown R.D. Jr et al. Prospective risk of hemorrhage in patients with vertebrobasilar nonsaccular intracranial aneurysm. J Neurosurg 2004;101(1):82–7. DOI: 10.3171/jns.2004.101.1.0082.
11. Xu D.S., Levitt M.R., Kalani M.Y.S. et al. Dolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes. J Neurosurg 2018;128(2):560–6. DOI: 10.3171/2016.10.JNS161041.
12. Mizutani T., Miki Y., Kojima H., Suzuki H. Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 1999;45(2):253–9. DOI: 10.1097/00006123-199908000-00010.
13. Pico F., Labreuche J., Amarenco P. Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia. Lancet Neurol 2015;14(8):833–45. DOI: 10.1016/S1474-4422(15)00089-7.
14. Smoker W.R., Corbett J.J., Gentry L.R. et al. High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinicalpathologic correlation and review. AJNR Am J Neuroradiol 1986;7(1):61–72.
15. Yamada K., Hayakawa T., Ushio Y., Mitomo M. Cerebral arterial dolichoectasia associated with moyamoya vessels. Surg Neurol 1985;23(1):19–24. DOI: 10.1016/0090-3019(85)90154-5.
16. Blumenkopf B., Huggins M.J. Tuberous sclerosis and multiple intracranial aneurysms: case report. Neurosurgery 1985;17(5):797–800. DOI: 10.1227/00006123-198511000-00012.
17. Finney H.L., Roberts T.S., Anderson R.E. Giant intracranial aneurysm associated with Marfan’s syndrome. J Neurosurg 1976;45(3):342–7. DOI: 10.3171/jns.1976.45.3.0342.
18. Goldstein D.A., Timpone J., Cupps T.R. HIV-associated intracranial aneurysmal vasculopathy in adults. J Rheumatol 2010;37(2):226–33. DOI: 10.3899/jrheum.090643.
19. Passero S., Filosomi G. Posterior circulation infarcts in patients with vertebrobasilar dolichoectasia. Stroke 1998;29(3):653–9. DOI: 10.1161/01.str.29.3.653.
20. Pico F., Labreuche J., Touboul P.J., Amarenco P. Intracranial arterial dolichoectasia and its association with carotid atherosclerosis and stroke subtype. Neurology 2003;61(12):1736–42. DOI: 10.1212/01.wnl.0000103168.14885.a8.
21. Gautier J.C., Hauw J.J., Awada A. et al. [Dolichoectatic intracranial arteries. Association with aneurysms of the abdominal aorta (In French)]. Rev Neurol (Paris) 1988;144(6–7):437–46.
22. Hegedüs K. Ectasia of the basilar artery with special reference to possible pathogenesis. Surg Neurol 1985;24(4):463–9. DOI: 10.1016/0090-3019(85)90309-x.
23. Pico F., Labreuche J., Cohen A. et al. Intracranial arterial dolichoectasia is associated with enlarged descending thoracic aorta. Neurology 2004;63(11):2016–21. DOI: 10.1212/01.wnl.0000145845.12577.0f.
24. Tanaka M., Sakaguchi M., Miwa K. et al. Basilar artery diameter is an independent predictor of incident cardiovascular events. Arterioscler Thromb Vasc Biol 2013;33(9):2240–4. DOI: 10.1161/ATVBAHA.113.301467.
25. Michel J.B., Martin-Ventura J.L., Egido J. et al. Novel aspects of the pathogenesis of aneurysms of the abdominal aorta in humans. Cardiovasc Res 2011;90(1): 18–27. DOI: 10.1093/cvr/cvq337.
26. Gutierrez J., Sultan S., Bagci A. et al. Circle of Willis configuration as a determinant of intracranial dolichoectasia. Cerebrovasc Dis 2013;36(5–6): 446–53. DOI: 10.1159/000356347.
27. Ince B., Petty G.W., Brown R.D. Jr et al. Dolichoectasia of the intracranial arteries in patients with first ischemic stroke: a population-based study. Neurology 1998;50(6):1694–8. DOI: 10.1212/wnl.50.6.1694.
28. Endo S., Nishijima M., Nomura H. et al. A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature. Neurosurgery 1993;33(4):732–8. DOI: 10.1227/00006123-199310000-00026.
29. Day A.L., Gaposchkin C.G., Yu C.J. et al. Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 2003;99(2):228–40. DOI: 10.3171/jns.2003.99.2.0228.
30. Barletta E.A., Ricci R.L., Silva R.D.G. et al. Fusiform aneurysms: a review from its pathogenesis to treatment options. Surg Neurol Int 2018;9:189. DOI: 10.4103/sni.sni_133_18.
31. Onofrj V., Cortes M., Tampieri D. The insidious appearance of the dissecting aneurysm: imaging findings and related pathophysiology. A report of two cases. Interv Neuroradiol 2016;22(6):638–42. DOI: 10.1177/1591019916659265.
32. Yu Y.L., Moseley I.F., Pullicino P., McDonald W.I. The clinical picture of ectasia of the intracerebral arteries. J Neurol Neurosurg Psychiatry 1982;45(1):29–36. DOI: 10.1136/jnnp.45.1.29.
33. Nasr D.M., Flemming K.D., Lanzino G. et al. Natural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis. Cerebrovasc Dis 2018;45(1–2):68–77. DOI: 10.1159/000486866.
34. Mangrum W.I., Huston J. 3rd, Link M.J. et al. Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth. J Neurosurg 2005;102(1):72–9. DOI: 10.3171/jns.2005.102.1.0072.
35. Flemming K.D., Wiebers D.O., Brown R.D. Jr et al. The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovasc Dis 2005;20(4):270–9. DOI: 10.1159/000087710.
36. Raphaeli G., Collignon L., De Witte O.D., Lubicz B. Endovascular treatment of posterior circulation fusiform aneurysms: single-center experience in 31 patients. Neurosurgery 2011;69(2):274–83. DOI: 10.1227/NEU.0b013e31821723f2.
37. Flemming K.D., Link M.J., Brown R.D. et al. Presentation and longterm outcome in radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Stroke 2003;34(1):275.
38. Sacho R.H., Saliou G., Kostynskyy A. et al. Natural history and outcome after treatment of unruptured intradural fusiform aneurysms. Stroke 2014;45(11):3251–6. DOI: 10.1161/STROKEAHA.114.006292.
39. Sun S., Jiang W., Wang J. et al. Clinical analysis and surgical treatment of trigeminal neuralgia caused by vertebrobasilar dolichoectasia: a retrospective study. Int J Surg 2017;41:183–9. DOI: 10.1016/j.ijsu.2017.04.015.
40. Bhogal P., Pérez M.A., Ganslandt O. et al. Treatment of posterior circulation nonsaccular aneurysms with flow diverters: a single-center experience and review of 56 patients. J Neurointerv Surg 2017;9(5):471–81. DOI: 10.1136/neurintsurg-2016-012781.
41. Shapiro M., Becske T., Riina H.A. et al. Non-saccular vertebrobasilar aneurysms and dolichoectasia: a systematic literature review. J Neurointerv Surg 2014;6(5):389–93. DOI: 10.1136/neurintsurg-2013-010793.
42. Mizutani T. A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg 1996;84(6):962–71. DOI: 10.3171/jns.1996.84.6.0962.
43. Lee W., Choo Y.S., Kim Y.B., Chung J. Neurological deterioration after decompressive suboccipital craniectomy in a patient with a brainstem-compressing thrombosed giant aneurysm of the vertebral artery. J Cerebrovasc Endovasc Neurosurg 2016;18(2):115–9. DOI: 10.7461/jcen.2016.18.2.115.
44. Siddiqui A., Chew N.S., Miszkiel K. Vertebrobasilar dolichoectasia: a rare cause of obstructive hydrocephalus. Br J Radiol 2008;81(964):e123–6. DOI: 10.1259/bjr/27603660.
45. Zambrino C.A., Berardinelli A., Martelli A. et al. Dolicho-vertebrobasilar abnormality and migraine-like attacks. Eur Neurol 1999;41(1):10–4. DOI: 10.1159/000007991.
46. Guirgis M.F., Lam B.L., Falcone S.F. Optic tract compression from dolichoectatic basilar artery. Am J Ophthalmol 2001;132(2):283–6. DOI: 10.1016/s0002-9394(01)00869-8.
47. Gutierrez J., Sacco R.L.,Wright C.B. Dolichoectasia – an evolving arterial disease. Nat Rev Neurol 2011;7(1):41–50. DOI: 10.1038/nrneurol.2010.181.
48. Passero S.G., Calchetti B., Bartalini S. Intracranial bleeding in patients with vertebrobasilar dolichoectasia. Stroke 2005;36(7):1421–5. DOI: 10.1161/01.STR.0000172311.64662.9c.
49. Drake C.G., Peerless S.J. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 1997;87(2):141–62. DOI: 10.3171/jns.1997.87.2.0141.
50. Lawton M.T., Abla A.A., Rutledge W.C. et al. Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. Neurosurgery 2016;79(1):83–99. DOI: 10.1227/neu.0000000000001175.
51. Элиава Ш.Ш., Пилипенко Ю.В., Шехтман О.Д. и др. Микрохирургическое лечение аневризм позвоночных и задних нижних мозжечковых артерий: хирургические доступы, варианты выключения, результаты лечения. Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко 2019;83(4):5–17. DOI: 10.17116/neiro2019830415.
52. Горощенко С.А., Петров А.Е., Рожченко Л.В. и др. Хирургическое лечение крупных и гигантских аневризм вертебробазилярного бассейна, проявляющихся симптоматикой компрессии ствола головного мозга. Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко 2018;82(4):32–7. DOI: 10.17116/neiro201882432.
53. Thiex R., Mull M. Basilar megadolicho trunk causing obstructive hydrocephalus at the foramina of Monro. Surg Neurol 2006;65(2):199–201. DOI: 10.4103/sni.sni_162_17.
54. Операции реваскуляризации головного мозга в сосудистой нейрохирургии. Под ред. В.В. Крылова, В.Л. Леменева. М.: Бином, 2014. 272 с.
55. Хирургия сложных аневризм головного мозга. Под ред. В.В. Крылова. М.: АБВ-пресс, 2019. 308 с.
56. Lawton M.T. Seven bypasses: tenets and techniques for revascularization. Thieme, 2018. 698 p.
57. Kim B.M., Shin Y.S., Kim S.H. et al. Incidence and risk factors of recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms. Stroke 2011;42(9):2425–30. DOI: 10.1161/STROKEAHA.111.617381.
58. Coert B.A., Chang S.D., Do H.M. et al. Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms. J Neurosurg 2007;106(5):855–65. DOI: 10.3171/jns.2007.106.5.855.
59. Cohen M.M., Hemalatha C.P., D’Addario R.T., Goldman H.W. Embolization from a fusiform middle cerebral artery aneurysm. Stroke 1980;11(2):158–61. DOI: 10.1161/01.str.11.2.158.
60. Lubicz B., Collignon L., Lefranc F. et al. Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents. Neuroradiology 2008;50(6):499–507. DOI: 10.1007/s00234-008-0366-x.
61. Won Y.S., Rho M.H., Chung E.C. et al. Multiple overlapping stent-assisted coiling of complex aneurysms: a single-center experience. Neurol Res 2015;37(3):189–96. DOI: 10.1179/1743132814Y.0000000444.
62. Wehman J.C., Hanel R.A., Levy E.I., Hopkins LN. Giant cerebral aneurysms: endovascular challenges. Neurosurgery 2006;59(5 Suppl 3):125–38. DOI: 10.1227/01.NEU.0000237330.11482.90.
63. Zhang Y., Tian Z., Sui B. et al. Endovascular treatment of spontaneous intracranial fusiform and dissecting aneurysms: outcomes related to imaging classification of 309 cases. World Neurosurg 2017;98:444–55. DOI: 10.1016/j.wneu.2016.11.074.
64. Fischer S., Vajda Z., Aguilar Perez M. et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology 2012;54(4):369–82. DOI: 10.1007/s00234-011-0948-x.
65. Martin A.R., Cruz J.P., Matouk C.C. et al. The pipeline flow-diverting stent for exclusion of ruptured intracranial aneurysms with difficult morphologies. Neurosurgery 2012;70(1 Suppl Operative):21–8. DOI: 10.1227/NEU.0b013e3182315ee3.
66. McAuliffe W., Wenderoth J.D. Immediate and midterm results following treatment of recently ruptured intracranial aneurysms with the Pipeline embolization device. AJNR Am J Neuroradiol 2012;33(3):487–93. DOI: 10.3174/ajnr.A2797.
67. Siddiqui A.H., Abla A.A., Kan P. et al. Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms. J Neurosurg 2012;116(6):1258–66. DOI: 10.3171/2012.2.JNS111942.
Рецензия
Для цитирования:
Кравец Л.Я., Погосян А.Д. Немешотчатые аневризмы: патогенез, клиника, методы лечения (обзор литературы). Нейрохирургия. 2020;22(3):76-83. https://doi.org/10.17650/1683-3295-2020-22-3-76-83
For citation:
Kravets L.Y., Pogosyan A.D. Non-saccular aneurysms: pathogenesis, clinic and methods of treatment (review). Russian journal of neurosurgery. 2020;22(3):76-83. (In Russ.) https://doi.org/10.17650/1683-3295-2020-22-3-76-83
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