Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms Clinical article
ABSTRACT Object Management of unruptured intracranial aneurysms remains controversial in neurosurgery. The contribution of morphological parameters has not been included in the treatment paradigm in a systematic manner or for any particular aneurysm location. The authors present a large sample of middle cerebral artery (MCA) aneurysms that were assessed using morphological variables to determine the parameters associated with aneurysm rupture. Methods Preoperative CT angiography (CTA) studies were evaluated using Slicer software to generate 3D models of the aneurysms and their surrounding vascular architecture. Morphological parameters examined in each model included 5 variables already defined in the literature (aneurysm size, aspect ratio, aneurysm angle, vessel angle, and size ratio) and 3 novel variables (flow angle, distance to the genu, and parent-daughter angle). Univariate and multivariate statistical analyses were performed to determine statistical significance. Results Between 2005 and 2008, 132 MCA aneurysms were treated at a single institution, and CTA studies of 79 aneurysms (40 ruptured and 39 unruptured) were analyzed. Fifty-three aneurysms were excluded because of reoperation (4), associated AVM (2), or lack of preoperative CTA studies (47). Ruptured aneurysms were associated with larger size, greater aspect ratio, larger aneurysm and flow angles, and smaller parent-daughter angle. Multivariate logistic regression revealed that aspect ratio, flow angle, and parent-daughter angle were the strongest factors associated with ruptured aneurysms. Conclusions Aspect ratio, flow angle, and parent-daughter angle are more strongly associated with ruptured MCA aneurysms than size. The association of parameters independent of aneurysm morphology with ruptured aneurysms suggests that these parameters may be associated with an increased risk of aneurysm rupture. These factors are readily applied in clinical practice and should be considered in addition to aneurysm size when assessing the risk of aneurysm rupture specific to the MCA location.
Article: Editorial: Aneurysm geometry.Journal of Neurosurgery 09/2012; DOI:10.3171/2012.3.JNS112260 · 3.15 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: International guidelines for the management of unruptured intracranial aneurysms (UIAs) recommend observation in aneurysms <10 mm due to the estimated low risk of rupture. The aim of our study was analyse the data of recently treated patients with ruptured cerebral aneurysms with the special focus on size and configuration in view of the frequency scale in a daily routine setting. METHODS: We reviewed the data of all patients with aneurysmal subarachnoid haemorrhage (SAH) during the last 24 months at our institution. Configuration and size of the aneurysms were measured. Clinical data were collected using the following classifications for analysis: Hunt and Hess (H&H), modified Rankin Scale (mRS) and Fisher classification. RESULTS: Data of 135 patients with aneurysmal SAH (98 women, 37 men; ratio 2.6:1) were analysed. Analysis showed that 19 aneurysms (14 %) were >10 mm (mean size, 19.2 mm) and 116 aneurysms (85.9 %) <10 mm (mean size, 6.2 mm). In total, 112 were categorised as berry-like configured aneurysms (n = 113 <10 mm, n = 3 >10 mm), 18 as multi-lobar (n = 16 <10 mm, n = 2 >10 mm) and 5 as fusiform (n = 4 <10 mm, n = 1, >10 mm). CONCLUSION: Since the results of our study showed that the majority of the aneurysms are <10 mm (mean, 6.2 mm), it is justified to challenge the recommendations of the international guidelines in a daily routine setting. We believe that the published data are not convincing enough to play a guidance role in daily routine. Due to improving surgical and endovascular techniques with satisfying results and the high number of ruptured small aneurysms, we believe a change in attitude in management of small-sized aneurysms is needed. Further diagnostic models are needed to determine the risk of rupture of intracranial aneurysms properly to obtain adequate treatment for UIAs.Acta Neurochirurgica 04/2013; 155(6). DOI:10.1007/s00701-013-1688-y · 1.79 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Aneurysm-to-vessel size ratio (SR) predicts rupture status based on the premise that large aneurysms on small vessels are more likely to rupture compared to small aneurysms on larger vessels. While simpler for sidewall-type (function of proximal vessel [PV] only), SR methodology for bifurcation aneurysms requires the overhead of daughter vessels measurement. This study sets to evaluate SR performance on bifurcation aneurysms, and determine the added value of including daughters? Methods: Catheter 3D-rotational angiograms of 154 bifurcation aneurysms (54 ruptured) were available. Aneurysms were evaluated for height (H) and maximal size (Dmax). Vessel size was evaluated as PV, daughter vessels average (DV), and parent and daughter vessels average (PDV). First, SR was evaluated as SR1PDV=H/PDV and SR2PDV=Dmax/PDV. Second, SR function of the parent vessel only was evaluated as SR1PV=H/PV and SR2PV=Dmax/PV. Statistical significance was assumed for P<0.05. Area under the curve (AUC) was evaluated. Unexpectedly, parent vessel only definitions, SR1PV (P<0.001, AUC=0.69) and SR2PV (P=0.002, AUC=0.64), performed marginally better as rupture status discriminators compared to the corresponding parent and daughter vessels definitions, SR1PDV (P=0.001, AUC=0.67) and SR2PDV (P=0.01, AUC=0.63), respectively. Parameters including daughter vessel measurements (DV, PDV, DV/PV) were not significant. Not only is the inclusion of daughter measurements not statistically justified, it may be detrimental to SR performance. Parent-only SR definitions simplify the aneurysmal morphological evaluation at no performance loss. It is reasonable to employ a unified approach regardless of sidewall/bifurcation labeling, by defining SR as aneurysm size to parent vessel ratio and omitting the measurements of the daughter branches.Neurological Research 06/2013; 35(9). DOI:10.1179/1743132813Y.0000000231 · 1.45 Impact Factor