Endo S, Nishijima M, Nomura H, Takaku A, Okada E
Department of Neurosurgery and Pathology, Toyama Medical and Pharmaceutical University, Japan.
Neurosurgery. 1993 Oct;33(4):732-8. doi: 10.1227/00006123-199310000-00026.
Three autopsied cases of dissecting aneurysms with spontaneous subarachnoid hemorrhage of the intracranial posterior circulation are reported, and the literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. The location and pathological features of the aneurysms were different in each of the cases presented. Subadventitial hemorrhage associated with the subarachnoid hemorrhage, multiple noncontiguous intramural hemorrhages, and new vessels in and around the arterial wall were noteworthy findings in our series. All 20 reported autopsied cases of the vertebrobasilar artery have a dissection between the media and adventitia with a rupture site in the thin adventitia. Seventeen of them had disruption of the entire arterial wall, but the remaining three cases had no apparent luminal connection. The clinicopathological features of this disease are various. On the basis of the pathological investigations of these reported cases, the pathogenesis of this lesion is discussed. Intramural hemorrhage associated with dissection without luminal connection should not be disregarded as a causative factor.
报告了3例颅内后循环夹层动脉瘤伴自发性蛛网膜下腔出血的尸检病例，并复习文献以研究该病变的病理特征和发病机制。所呈现的每个病例中动脉瘤的位置和病理特征各不相同。在我们的系列病例中，与蛛网膜下腔出血相关的外膜下出血、多个不连续的壁内出血以及动脉壁内和周围的新生血管是值得注意的发现。所有20例已报道的椎基底动脉尸检病例均在中膜和外膜之间有夹层，破裂部位位于薄的外膜。其中17例动脉壁全层破裂，但其余3例无明显的管腔连接。该疾病的临床病理特征多种多样。基于这些已报道病例的病理研究，讨论了该病变的发病机制。与夹层相关的无管腔连接的壁内出血不应被忽视作为一个致病因素。
