Abstract
Introduction
Infundibula are symmetrical funnel-shaped widening, measuring more than 3 mm at its base with the branch artery arising from its apex. The pathological significance of this entity remains controversial. Although a relatively common appearance in otherwise normal angiograms, they have occasionally been described to progress into saccular aneurysms or directly rupture.
Methods/Results
We describe the first case of a disappearing infundibulum after a flow diverting stent was deployed across the infundibulum during the treatment of an adjacent aneurysm.
Conclusions
We concur in the view that infundibula are at least pre-pathological lesions that may in certain circumstances require consideration for treatment. Our case for the first time offers a potential treatment option for such situations.
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References
Marshman LA, Ward PJ, Walter PH, Dossetor RS (1998) The progression of an infundibulum to aneurysm formation and rupture: case report and literature review. Neurosurgery 43:1445–1448
Martins C, Macanovic M, Silva IE C, Griz F, Azevedo-Filho HR (2002) Progression of an arterial infundibulum to aneurysm: case report. Arq Neuropsiquiatr 60:478–480
Fischer S, Hopf N, Henkes H (2011) Evolution from an infundibulum of the posterior communicating artery to a saccular aneurysm. Clin Neuroradiol 21:87–90
Saltzmann GF (1959) Infundibular widening of the posterior communicating artery studied by carotid angiography. Acta Radiol 51:415–421
Wollschlaeeger G, Wollschlaeger PB, Lucas FV, Lopez VF (1967) Experience and result with postmortem cerebral angiography performed as a routine procedure of the autopsy. Am J Roent 101:68–87
Ebina K, Ohkuma H, Iwabuchi T (1986) An angiographic study of incidence and morphology of infundibular dilatation of the posterior communicating artery. Neuroradiology 28:23–29
Ohyama T, Ohara S, Momma F (1994) Fatal subarachnoid hemorrhage due to ruptured infundibular widening of the posterior communicating artery: access report. Neurol Med Chir (Tokyo) 34:172–175
Edelsohn L, Caplan L, Rosenbaum AE (1972) Familial aneurysms and infundibular widening. Neurology 22:1056–1060
Leblanc R, Worsley KJ, Melanson D, Tampieri D (1994) Angiographic screening and elective surgery of familial cerebral aneurysms: a decision analysis. Neurosurgery 35:9–18
Miyasaka K, Wolpert SM, Prager RJ (1982) The association of cerebral aneurysms, indundibula, and intracranial arteriovenous malformations. Stroke 13:196–203
Cowan JA Jr, Barkhoudarian G, Yang LJ, Thompson BG (2004) Progression of a posterior communicating artery infundibulum into an aneurysm in a patient with Alagille syndrome. Case report. J Neurosurg 101:694–696
Epstein F, Ransohoff J, Budzilovich GN (1970) The clinical significance of junctional dilation of the posterior communicating artery. J Neurosurg 33:529–531
Stuntz JT, Ojemann GA, Alvord EC (1970) Radiographic and histological demonstration of an aneurysm developing on the infundibulum of the posterior communicating artery. J Neurosurg 33:591–595
Archer CR, Silbert S (1978) Infundibula may be clinically significant. Neuroradiology 15:247–251
Trasi S, Vincent LM, Zingesser LH (1981) Development of aneurysm from infundibulum of posterior communicating artery with documentation of prior hemorrhage. Am J Neuroradiol 2:368–370
Koike G, Seguchi K, Kyoshima K, Kobayash S (1994) Subarachnoid haemorrhage due to rupture of infundibular dilation of a circumflex branch of the posterior cerebral artery: case report. Neurosurgery 34:1075–1077
Hassler O, Saltzmann G-F (1959) Histological changes in infundibular widening of the posterior communicating artery. Acta Path Micro Scand 46:305–312
Hassler O, Saltzmann G-F (1963) Angiographic and histologic changes in infundibular widening of the posterior communicating artery. Acta Radiol Diagn (Stockh) 1:321–327
Punt J (1979) Some observations on aneurysms of the proximal internal carotid artery. J Neurosurg 51:151–154
Glynn LE (1940) Medial defects of the circle of Willis and their relation to aneurysmal formation. J Path Bact 51:213–222
Roach MR (1963) Changes in arterial distensibility as a cause of post-stenotic dilatation. Amer J Cardiol 12:351–470
Stehbens WE (1963) Histopathology of cerebral aneurysms. Arch Neurol 8:272–285
Bjorkesten G, Troupp H (1962) Changes in the size of intracranial arterial aneurysms. J Neurosurg 19:583–588
Drake CG (1966) On the surgical treatment of ruptured intracranial aneurysms. Clin Neurosurg 13:122–155
Yoshimoto T, Suzuki J (1974) Surgical treatment of an aneurysm on the funnel-shaped bulge of the posterior communicating artery. J Neurosurg 41:377–379
Young B, Meacham F, Allen JH (1971) Documented enlargement and rupture of a small arterial sacculation: case report. J Neurosurg 34:814–817
Patrick D, Appleby A (1983) Infundibular widening of the posterior communicating artery progressing to true aneurysm. Br J Radiol 56:59–60
Itakura T, Ozaki F, Nakai FT, Hayashi S, Komai N (1983) Bilateral aneurysm formation developing from junctional dilatation (infundibulum) of the posterior communicating artery: case report. J Neurosurg 58:117–119
Radulovic D, Nestorovic B, Rakic M, Janosevic V (2006) Enlargement to a saccular aneurysm and subsequent rupture of infundibular widening of posterior communicating artery. Neurochirurgie 52:525–528
Takahashi C, Fukuda O, Hori E, Kameda H, Endo S (2006) A case of infundibular dilatation development into an aneurysm and rupturing after the rupture of an aneurysm 10 years ago. No Shinkei Geka 34:613–617
Waga S, Morikawa A (1979) Aneurysm developing on the infundibular widening of the posterior communicating artery. Surg Neurol 11:125–127
Kuwahara S, Uga S, Mori K (2001) Successful treatment of a ruptured enlarged infundibular widening of the posterior communicating artery—case report. Neurol Med Chir (Tokyo) 41:25–28
Coupe NJ, Athwal RK, Marshman LA, Brydon HL (2007) Subarachnoid hemorrhage emanating from a ruptured infundibulum: case report and literature review. Surg Neurol 67:204–206
Yu J, Wang H, Xu K, Wang B, Luo Q (2010) Endovascular embolization of ruptured infundibular dilation of posterior communicating artery: A case report. Case Reports in Medicine. Published online 2010 December 27; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014759
Baek H, Jayaraman MV, Karniadakis GE (2009) Wall shear stress and pressure distribution on aneurysms and infundibulae in the posterior communicating artery bifurcation. Ann Biomed Eng 37:2469–2487
González-Darder JM, Verdú-López F, Quilis-Quesada V (2011) Management of microsurgical treatment of infundibular dilatations of the posterior communicating artery. Series of nine cases and a review of the literature. Neurocirugia (Astur) 22:301–309
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Kameda-Smith, M.M., Du Plessis, J.C. & Bhattacharya, J.J. First demonstration of resolution of an infundibulum by direct treatment of the arterial wall with Pipeline flow-diverting stent. Neuroradiology 56, 35–39 (2014). https://doi.org/10.1007/s00234-013-1295-x
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DOI: https://doi.org/10.1007/s00234-013-1295-x