Konovalov Anton, Gadzhiagaev Vadim, Artemyev Anton, Okishev Dmitry, Pilipenko Yuri, Grebenev Fyodor, Eliava Shalva
Cerebrovascular Surgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS.
Neurosurgery, National Medical Research Center of Neurosurgery Named After N. N. Burdenko, Moscow, RUS.
Cureus. 2024 Apr 28;16(4):e59185. doi: 10.7759/cureus.59185. eCollection 2024 Apr.
Modern neuroimaging methods do not completely rule out false diagnoses of intracranial aneurysms which can lead to an unwarranted operation associated with risks of complications. However, surgical interventions for falsely diagnosed aneurysms are quite rare. The purpose of this study is to demonstrate two clinical cases of false-positive aneurysms and a systematic review of the literature dedicated to the incidence and etiology of false-positive aneurysms, identifying risk factors associated with false-positive aneurysms. A literature search in two databases (PubMed and Web of Science) using keywords "mimicking an intracranial aneurysm", "presenting as an intracranial aneurysm", "false positive intracranial aneurysms", and "neurosurgery" was conducted. A total of 243 papers were found in the initial search in two databases. Sixteen papers (including 20 patients) were included in the final analysis. There were 10 women and 10 men. The most common location of false-positive aneurysms was the bifurcation of the middle cerebral artery (MCA). In the posterior circulation, false-positive aneurysms were identified either on the basilar artery, or at the vertebro-basilar junction. The main causes of false intracranial aneurysm diagnosis included artery occlusion with vascular stump formation, infundibular widening, fenestration, arterial dissection, contrast extravasation, and venous varix. In conclusion, summarizing the results of our analysis, we can say that surgical interventions for false-positive aneurysms are an underestimated problem in vascular neurosurgery. Despite extremely rare published clinical observations, the actual frequency of erroneous surgical interventions for false-positive aneurysms is unknown.
现代神经影像学方法并不能完全排除颅内动脉瘤的误诊，而误诊可能导致不必要的手术，并伴有并发症风险。然而，针对误诊动脉瘤的手术干预相当罕见。本研究的目的是展示两例假阳性动脉瘤的临床病例，并对有关假阳性动脉瘤的发生率和病因的文献进行系统综述，以确定与假阳性动脉瘤相关的危险因素。我们使用关键词“模拟颅内动脉瘤”、“表现为颅内动脉瘤”、“假阳性颅内动脉瘤”和“神经外科”在两个数据库（PubMed和Web of Science）中进行了文献检索。在两个数据库的初步检索中总共找到243篇论文。最终分析纳入了16篇论文（包括20例患者）。其中男性10例，女性10例。假阳性动脉瘤最常见的位置是大脑中动脉（MCA）分叉处。在后循环中，假阳性动脉瘤可在基底动脉或椎基底交界处发现。颅内动脉瘤误诊的主要原因包括血管残端形成导致的动脉闭塞、漏斗部增宽、开窗、动脉夹层、造影剂外渗和静脉瘤样扩张。总之，总结我们的分析结果可以说，假阳性动脉瘤的手术干预在血管神经外科中是一个被低估的问题。尽管已发表的临床观察极其罕见，但假阳性动脉瘤错误手术干预的实际发生率尚不清楚。
