<Originals>Morphological changes in the vascular endothelial cell layer and wall of cerebral aneurysm before and after rupture
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概要
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Following the use of magnetic resonance imaging as a diagnostic tool, the number of diagnosed unruptured cerebral aneurysms has increased, and the risk of bleeding from a previously unruptured aneurysm is relatively low. It is important to determine unruptured aneurysms that have a higher risk of bleeding. The present study was investigates the mechanisms in an unruptured aneurysm that lead it to rupture. Eighteen ruptured and 12 unruptured aneurysmal sacs were obtained from 29 patients after clipping of the aneurysmal neck. Their inner surface was examined by a scanning electron microscope (SEM), and the walls of the aneurysms were studied by immunohistochemical methods. In 10 of 18 ruptured aneurysms, the endothelial cell layer was extensively damaged : the aneurysmal wall exhibited scattered smooth muscle cells, irregular layer of collagen Type IV and hyaline-like structures. In the other 8 ruptured aneurysms, the endothelial cell layer in areas remote from the rupture point was nearly intact although disruption of the endothelium was observed near the rupture point ; the aneurysmal walls showed various degrees of damage. The inner surface in 8 of 12 unruptured aneurysms was covered with normal endothelial cells. The endothelium in the other 4 showed various degrees of damage. In 4 of 5 unruptured aneurysms with normal endothelial cell layers, the smooth muscle cells and the layer of collagen Type IV were well preserved. The present study reveals that the pathology of unruptured aneurysms differs to that of ruptured aneurysms in the structure of the aneurysmal sac. In addition, I reveal two reasons for rupture. One reason is an increase in intraaneurysmal pressure results in enlargement which leads to stretching of the aneurysmal wall and couses extensive endothelial damage and disruption of the wall structure. The other reason is that a limited portion of the aneurysmal wall is weakened and stretched by an increase in the intraaneurysmal pressure, and bleeding can occur from this site while other parts of the aneurysmal wall remain intact.
- 近畿大学の論文
著者
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Yasuda Masaaki
Department Of Bioscience And Biotechnology Faculty Of Agriculture University Of Ryukyus
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Yasuda Masaaki
Department Of Neurosurgery Kinki University School Of Medicine
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