Angiographic infundibular dilation: Is it worth exploring?

Italo Nogarotto Cembraneli,José Edison Da Silva Cavalcante,Julia Brasileiro De Faria Cavalcante,Pedro Nogarotto Cembraneli,Renata Brasileiro De Faria Cavalcante,Rherold Santana,Volmer Fernandes Valente Junior

doi:10.5348/101182z01pc2020cr

Italo Nogarotto Cembraneli, José Edison Da Silva Cavalcante + Show 5 more

Open Access

https://doi.org/10.5348/101182z01pc2020cr

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Abstract

Introduction: Infundibular dilations are generally considered normal anatomical variants devoid of pathogenic significance. However, some of them change in time and show certain characteristics similar to saccular aneurysms. Case Report: A 40-year-old male patient was hospitalized due to subarachnoid hemorrhage, resulting from the rupture of an aneurysm at the level of the anterior communicating artery. Additionally, an infundibular dilation of 6 mm in diameter was detected at the level of the right posterior communicating artery. The patient underwent an open surgery, using the pterional craniotomy approach to the right. The aneurysm of the anterior communicating artery was clipped with some difficulty because previous hemorrhage and hematoma were covering the aneurysmal neck. A mini clip was used to laterally decrease the infundibular dilation. Upon releasing the clip, we evidenced not an infundibulum, but a typical aneurysm, with the posterior communicating artery well attached to its wall, which was released and exposed at the time of clipping. Conclusion: Infundibular dilation is a potential source of bleeding, but it rarely ruptures and is little valued by radiologists and neurosurgeons. The care inherent in the discovery of an infundibular aneurysm, even if it is insidious, must be the same as that applied to classical types of aneurysm. Moreover, the therapeutic approach should be chosen when the infundibular aneurysm is equal to or greater than 4 mm in diameter.

Highlights

Infundibular dilations are generally considered normal anatomical variants devoid of pathogenic significance
The care inherent in the discovery of an infundibular aneurysm, even if it is insidious, must be the same as that applied to classical types of aneurysm
Some of them change in time and show certain characteristics that are similar to saccular aneurysms [3, 4]

Summary

INTRODUCTION

The posterior communicating arteries originate from the cerebral part of the internal carotid arteries on both sides, mainly due to the posterolateral or posterior aspect, and after a course of approximately 12 mm it International Journal of Case Reports and Images, Vol 11, 2020. Radiological control is usually disregarded even by the patients They are often only diagnosed in the presence of subarachnoid hemorrhage, when they rupture [5,6,7]. A 40-year-old male patient, with no previous diseases, was hospitalized due to subarachnoid hemorrhage, resulting from the rupture of an aneurysm at the level of the anterior communicating artery, diagnosed through conventional cerebral angiography, by catheterization (Figure 1). In addition to this aneurysm, an infundibular dilation of 6 mm in diameter was detected at the level of the right posterior communicating artery (Figures 2 and 3). The aneurysm of the anterior communicating artery was clipped with some difficulty, since previous hemorrhage and hematoma were covering the aneurysmal neck

DISCUSSION

CONCLUSION