Intracranial arterial aneurysms / by Walter E. Dandy.

  • Walter Dandy
Date:
1944
Catalogue details

Licence: In copyright

Credit: Intracranial arterial aneurysms / by Walter E. Dandy. Source: Wellcome Collection.

    14/178 (page 4)
    and if those in the carotid canal are added to those on the intracranial portion, they are about twice as common (44.4 per cent) as those of the anterior cerebral, middle cerebral, or basilar (including the verte¬ bral), on all of which aneurysms occur with essentially the same fre¬ quency. This has an important bearing on the surgical treatment, because carotid aneurysms offer much the most hopeful prospects of a surgical cure. Statistical studies of this nature from the literature show marked differences. However, that of McDonald and Korb (1939) is much the most valuable, because most of the 1125 cases reported could be included. Their figures, in 1023 cases differ from those in this report. Their total on the internal carotid artery was 19 per cent, mine 44.0 per cent; theirs on the anterior cerebral and anterior communicating; was 23 per cent, mine 19 per cent; on the middle cerebral 29 per cent, mine 20 per cent; on the basilar and vertebral arteries 21 per cent; mine 16 per cent. Gull (1859) found 40 per cent on the basilar and vertebral arteries, and 24 per cent on the middle cerebral arteries. Richardson and Hy¬ land (1941) reported 53 necropsies of intracranial aneurysms with a fairly even distribution on the major trunks; the highest incidence (30 per cent) was on the middle cerebral; for the anterior cerebral and communicating arteries it was 25 per cent, and for the internal carotid, 25 per cent. Berger (1923) reported 25 per cent of 21 aneu¬ rysms from the basilar and vertebral arteries. Lebert (1866), in 53 cases, reported the middle cerebral artery to be involved in much the highest proportion (40 per cent). I he present series is strikingly defective in aneurysms of the pos¬ terior communicating arteries, there being none. In nearly every other series from 2 to 10 per cent of the aneurysms are from this ves¬ sel (McDonald and Korb, 4 per cent). The explanation of this dif¬ ference is, I think, quite clear. Most of these aneurysms arise at or very near the junction of these two trunks and they usually lie on the posterior communicating artery, frequently concealing it and giving the superficial impression that the sac arises from it, but if the orifice is carefully examined it will usually be found to enter the carotid. The higher incidence of basilar and vertebral aneurysms in some of the other reports should also be noted (Gull, 40 per cent; Berger, 25 pei cent). W hen it is considered that 11 of our 21 cases were dis¬ closed during operations for trigeminal neuralgia and Meniere’s