HSOA Journal of Surgery: Current Trends & Innovations Intradural Internal Carotid Artery Fusiform Aneurysm: A Review of Literature

severely limit quality of life. The neu-ropathic mechanism is related to tissue damage, paraneoplastic Abstract An aneurysm is a localized or dilation of an artery with a diameter of at least 50% higher than the average size of an artery. Intramural internal carotid artery aneurysm is likely to occur in different locations, mostly at the intersecting point of smaller vessels, and is typically saccular. However, fusiform and blister aneurysms may also occur. The multiplicity of an aneurysm is common in patients having Internal Carotid Artery (ICA) aneurysms. For this study, the population of the fusiform aneurysm did present instances of hemorrhage; other five did present dizziness without headache while four others did present ischemia deficit and single patient with abducent nerve palsy from effects of the aneurysm. Most of the studies did indicate that the condition presents with various neurological symptoms and deeply affects quality of life.


Methods
The study did examine the various health journal that looks into the key elements or aspect of the disease, numerous studies were reviewed which relate the prevalence rate and other issues of the disease like the key symptoms and signs, the prognosis and the patient education which is very vital for the patients [11]. The study did examine the various studies which have been in the past present actual findings on the fusiform aneurysm [12]. The study result will be used to make a concussive discussion that will inform the same knowledge on the condition [13].

Results
According to the review of the various journals on the disease that were considered for the study, fusiform aneurysm has included a heterogeneous population of both ruptured and uncultured fusiform aneurysm and are limited by small numbers [14]. This is regarded as the first consecutive series describing the natural history of the patients with a fusiform intramural aneurysm that distinguishes those who are atherosclerotic and those who are not [15].
Unique to this study are the findings that the risk of adverse clinical events or rupture is quite low in patients with a fusiform aneurysm. The disease is quite common in women than men; it is also common in ages above 50 years. Among 2,458 patients treated for aneurysm between 1982 and 2007, 22 were having a fusiform aneurysm, an indication that the disease is rare [16].

Genetics
When a complete exam sequencing analysis was performed in a patient with a family history of this disease, aneurysm in various arterial beds had common risks and genetic factors [17]. The congregation of duplication with the aortic phenotype in the family showed a relationship between the repetition and aortic disease [18]. The variants in candidates' genes showed that there is likely to be a modification that contributes to the duplication 16p13.1on the disease [19].

Pathophysiology
Pain affects up to half of all cancer patients, and intractable pain in terminally ill patients can severely limit quality of life. The neuropathic mechanism is related to tissue damage, paraneoplastic inflammatory mediator secretion, nerve damage, and a variety of cancer treatments. The pathophysiology is categorized according to the shape of the non-vascular and saccular aneurysm. The fusiform aneurysm is nonvascular dilations involving a short distance of the whole vessel wall and is termed cylindrical [20]. This is often caused by atherosclerosis or dissection. The fusiform aneurysm has various underlying pathologies, anatomical distributions, natural histories, and treatment. The patients often have symptoms and signs of arterial rupture, occlusion, and a mass effect [21].

Biochemistry
Carotid artery aneurysm is uncommon and presents a therapeutic challenge to doctors [22]. A carotid artery aneurysm is often defined as the internal carotid artery dilation of the common carotid artery is more significant than the 150% of the diameter of the normal healthy artery [23]. The initial diagnosis of the carotid artery aneurysm is by duplex ultrasound imaging [24]. A computerized tomography angiography can, however, provide additional and valuable information, especially when the surgical exclusion of the aneurysm is to be considered [25]. Recently, the imaging of the vessel wall with an enhanced magnetic resonance with gadolinium was explored, which was able to add more additional information regarding aneurysm wall changes during the clinical follow-up. With patients with a growing aneurysm or related aneurysm symptoms, an open surgical repair has always been the accepted treatment [26].

Clinical implication
Dissection has been noted to be the primary underlying cause of the fusiform aneurysm and most commonly involves the posterior circulation that is the basilar arteries and vertebral. The dissecting aneurysm can originate in any region of the anterior circulation [27]. The follow-up and treatment of the disease are based on the presence and the type of symptoms, the lesion size, and its location and the risk of accompanying intervention [28].

Scientific analysis
The two articles which were considered in the study were Journal of Korean Neurosurgical Society and AHA journals [29]. The first article was more detailed and properly organized. The critical elements of the disorder were stipulated in the article, and this made is considerably easy to understand and simple to comprehend. The second journal was also informative. However, it did not give a piece of detailed information about the disease [30].

The limitations of the study
The unanswered question is the therapeutic challenges, the prevalence rate among women and adults above 50 years. The main problem which most scientific studies are still aiming to find is one in which the disease has a lower prevalence among persons below the age of 50. The other unanswered question is on the element of the variation in the age prevalence associated with this condition.

Conclusion
The non-atherosclerotic fusiform intradural aneurysm has a low risk of the adverse outcome within the first few years of diagnosis and may remain stable unless symptomatic on presentation. It is noted that high risks of treatment should be balanced. The atherosclerotic aneurysm has the worst natural history and may always represent a different disease entity.