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Toader C, Kakucs C, Dobrin N, Covache-Busuioc RA, Bratu BG, Popa AA, Glavan LA, Corlatescu AD, Grama MGN, Costin HP, Ciurea AV. Cerebral Aneurysm Characteristics and Surgical Outcomes: An In-Depth Analysis of 346 Cases Operated Using Microsurgical Clipping. Cureus 2024; 16:e56933. [PMID: 38665760 PMCID: PMC11043903 DOI: 10.7759/cureus.56933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
This comprehensive study analyzes 346 surgically treated intracranial aneurysms, emphasizing the importance of understanding risk factors and prevalent characteristics in patients. Intracranial aneurysms, primarily of the saccular or berry type, significantly contribute to nontraumatic subarachnoid hemorrhages and demonstrate a rising incidence due to advances in imaging techniques. The study highlights a gender discrepancy in aneurysm occurrence and a higher prevalence in individuals over 30 years old. The research delves into various aspects, including aneurysm localization, diameter, neck dimensions, and rupture status, with a focus on the anterior communicating artery and middle communicating artery as predominant locations. Significant findings include the prevalence of ruptured aneurysms and the impact of arterial hypertension, atherosclerosis, obesity, and diabetes on aneurysm epidemiology. The study also investigates the occurrence of vasospasm, a significant factor in delayed morbidity and mortality in aneurysmal subarachnoid hemorrhage. The utilization of the Glasgow Outcome Scale and other quantification scales aids in understanding the severity and postoperative outcomes of intracranial aneurysms. Challenges such as the incidence of reopenings and postoperative osteomyelitis are addressed, underlining the need for refined protocols and multidisciplinary approaches in treatment. The study's results contribute to the existing knowledge base on intracranial aneurysms, emphasizing the importance of ongoing research and tailored treatment strategies. The comprehensive nature of this analysis, covering preoperative, intraoperative, and postoperative factors, provides valuable insights into the complex interplay of risk factors and clinical outcomes in patients with intracranial aneurysms.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, Bucharest, ROU
| | - Cristian Kakucs
- Department of Neurosurgery, "Transilvania" University of Brasov, Faculty of General Medicine, Brasov, ROU
- Department of Neurosurgery, Clinical Emergency Hospital of Brasov, Brasov, ROU
| | - Nicolaie Dobrin
- Department of Neurosurgery, Clinical Emergency Hospital "Prof. Dr. Nicolae Oblu", Iasi, ROU
| | | | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Andrei Adrian Popa
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Luca-Andrei Glavan
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | | | | | - Horia-Petre Costin
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Alexandru Vladimir Ciurea
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Neurosurgery, Sanador Clinical Hospital, Bucharest, ROU
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Alam M, Mut F, Cebral JR, Seshaiyer P. Quantification of the Rupture Potential of Patient-Specific Intracranial Aneurysms under Contact Constraints. Bioengineering (Basel) 2021; 8:bioengineering8110149. [PMID: 34821715 PMCID: PMC8614820 DOI: 10.3390/bioengineering8110149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
Intracranial aneurysms (IAs) are localized enlargements of cerebral blood vessels that cause substantial rates of mortality and morbidity in humans. The rupture possibility of these aneurysms is a critical medical challenge for physicians during treatment planning. This treatment planning while assessing the rupture potential of aneurysms becomes more complicated when they are constrained by an adjacent structure such as optic nerve tissues or bones, which is not widely studied yet. In this work, we considered and studied a constitutive model to investigate the bio-mechanical response of image-based patient-specific IA data using cardiovascular structural mechanics equations. We performed biomechanical modeling and simulations of four different patient-specific aneurysms’ data (three middle cerebral arteries and one internal carotid artery) to assess the rupture potential of those aneurysms under a plane contact constraint. Our results suggest that aneurysms with plane contact constraints produce less or almost similar maximum wall effective stress compared to aneurysms with no contact constraints. In our research findings, we observed that a plane contact constraint on top of an internal carotid artery might work as a protective wall due to the 16.6% reduction in maximum wall effective stress than that for the case where there is no contact on top of the aneurysm.
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Affiliation(s)
- Manjurul Alam
- Department of Bio-Engineering, George Mason University, Fairfax, VA 22030, USA; (F.M.); (J.R.C.)
- Correspondence:
| | - Fernando Mut
- Department of Bio-Engineering, George Mason University, Fairfax, VA 22030, USA; (F.M.); (J.R.C.)
| | - Juan R. Cebral
- Department of Bio-Engineering, George Mason University, Fairfax, VA 22030, USA; (F.M.); (J.R.C.)
| | - Padmanabhan Seshaiyer
- Department of Mathematical Sciences, George Mason University, Fairfax, VA 22030, USA;
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Choi HS, Yoon JW, Seo H, Kang K, Kim JT. Diabetes is not protective against the formation of unruptured cerebral aneurysm. Clin Neurol Neurosurg 2021; 209:106944. [PMID: 34560386 DOI: 10.1016/j.clineuro.2021.106944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Diabetes appears to decrease the risk of subarachnoid hemorrhage. However, it is not clear whether diabetes decreases the risk of aneurysm formation. The aim of our study to evaluate the risk of unruptured cerebral aneurysm in patients with diabetes mellitus. METHODS We used data from participants who underwent brain magnetic resonance angiography (MRA) and laboratory tests at the Healthcare System Gangnam Center of Seoul National University Hospital between January 2010 and December 2013. From the 17,368 participants who underwent brain MRA, we analyzed 16,337 subjects whose diabetes status could be identified. RESULTS The number of participants with diabetes was 2299 (14.1%). The proportion of participants with cerebral aneurysms was 2.3% in the diabetic group and 2.7% in the non-diabetic group, which was not significantly different (P = 0.225). There were no significant differences in the size, location, and multiplicity of aneurysms between the diabetes and control groups. In multivariate logistic regression, older age showed significant risk effects on cerebral aneurysms, but female sex, hypertension, diabetes, obesity, and smoking did not show significant risk effects. CONCLUSION In this study, diabetes did not affect the risk of cerebral aneurysm formation. In addition, neither smoking, nor hypertension was a significant risk factor for unruptured cerebral aneurysms. The lack of association between cerebral aneurysm and the traditional risk factors for subarachnoid hemorrhage requires further study. Risk factors for cerebral aneurysm development and those for cerebral aneurysm rupture may be different.
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Affiliation(s)
- Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Gangwon-do, Republic of Korea
| | - Ji Won Yoon
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Hyobin Seo
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea.
| | - Jin Taek Kim
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea.
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Investigating the Association between Aortic Arch Variants and Intracranial Aneurysms. Can J Neurol Sci 2021; 49:364-367. [PMID: 33988114 DOI: 10.1017/cjn.2021.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is an association between anterior cerebral artery vessel asymmetry and anterior communicating artery aneurysm, presumably based on flow dynamics. The purpose of this study is to investigate the potential relationship between aortic arch branching patterns and incidence of intracranial aneurysm. METHODS This study included patients scanned over 1 year at our tertiary care center who underwent high-resolution imaging (computed tomography angiography or digital subtracted angiogram) of the head and neck arteries, aortic arch, and superior mediastinum. Exclusion criteria included patients with suboptimal images. Patient age, gender, aortic arch branching pattern, and the presence, location, and number of aneurysms were documented. RESULTS Among the 1082 patients analyzed, 250 (23%) patients had a variant aortic arch branching pattern, 22 (8.8%) of whom had aneurysms. There were 104 patients with 126 aneurysms, with majority of patients with normal aortic arch branching pattern (n = 82, 79%). The most common variant was a common origin of the left common carotid artery and brachiocephalic trunk with or without direct origin of the left vertebral artery. Twenty-two patients with aneurysms had an aberrant aortic arch (21%), compared to 232 patients without an aneurysm (24%). Fischer exact test showed no statistically significant difference between the incidence of aneurysm with different aortic arch variant groups (two-tailed p-value = 0.715). CONCLUSION To our knowledge, this is the first study to examine the association between aortic arch branching patterns and incidence of intracranial aneurysm. No significant association was found between aortic arch branching pattern and the incidence of intracranial aneurysm.
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Zheng J, Zhou R, Meng B, Li F, Liu H, Wu X. Knowledge framework and emerging trends in intracranial aneurysm magnetic resonance angiography: a scientometric analysis from 2004 to 2020. Quant Imaging Med Surg 2021; 11:1854-1869. [PMID: 33936970 DOI: 10.21037/qims-20-729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background As magnetic resonance angiography (MRA) has been increasingly used in the follow-up of intracranial aneurysms (IAs) as a non-invasive technique, the knowledge framework and areas of research interest in intracranial aneurysms magnetic resonance angiography (IAMRA) change approximately every 10 years. However, few studies have quantitatively analyzed the published literature in this field. In the present study, we used scientometrics to survey the knowledge field, development trends, and research focus of IAMRA with the aim of providing a reference for further study. Methods We collected articles on IAMRA published from 2004 (Jan 1, 2004) to 2020 (May 24, 2020). Web of Science Core Collection databases (WoSCCd) including the Science Citation Index Expanded were searched. An experienced staff member from the Department of Radiology at Southern Medical University, assisted in screening articles for relevant articles. We used ArcGIS (a mapping and location analytics platform) to perform geographic visualization. Excel 2016 was used to analyze the literature data, including number of publications, impact factor (IF), and publication year. CiteSpace V was used to conduct a series of literature feature clustering, including author co-citation analysis, reference co-citation analysis (RCA), and burst keywords analysis. Results A total of 1,272 articles on IAMRA published between 2004 and 2020 were included. Of 257 journals, American Journal of Neuroradiology (IF 2018: 3.256) published the most IAMRA articles (109 publications, 8.57%), followed by Journal of Neurosurgery (IF 2018: 4.131, 51 publications, 4.16%), and Neuroradiology (IF 2018: 2.504, 51 publications, 4.01%). Of 56 countries, the USA published the most, with 347 articles [27.28%, IF: 3.14 (average IF of all journals in the country)], followed by Japan (242 articles, 19.03%, IF: 2.38), Germany (135 articles, 10.61%, IF: 3.21), and China (101 articles, 7.94%, IF: 2.86). A total of 1387 institutions published articles, with the Mayo Clinic publishing the most (33 articles, 2.59%), followed by Shanghai Jiao Tong University (25 article, 1.97%), Seoul National University (23 articles, 1.81%), and University Medical Center Utrecht (19 articles, 1.49%). Of 399 authors, Rinkel ranked first with 19 articles, followed by Li MH (18 articles), Uchino A (15 articles), and Saito N (13 articles). Cluster RCA showed that the first cluster was "#0 growth", followed by "#1 Guglielmi detachable coils". Timeline views showed that the time span of "#0 growth" was the closest to today. The modularity value was 0.6971, and the mean silhouette value was 0.5477. According to the burst keyword analysis, "risk factors associated to rupture" was the topic with the strongest burst since 2017. Studies conducted in several countries suggested that age is inversely related to the risk of rupture, which implies the importance of MRA follow-up for patients of different age. Conclusions From 2004 to 2020, the number of published IAMRA-related articles gradually increased. The USA and Western Europe lead in the field, with a concentration of cutting-edge talents and high-level scientific research institutions. A synthesis of the clustering results of RCA and burst keyword analysis indicated that unruptured IA growth, stent-assisted coil embolization, and risk factors associated to rupture were the current hotspots in IAMRA research.
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Affiliation(s)
- Jiazhen Zheng
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Bingyao Meng
- Department of Radiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Furong Li
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Huamin Liu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
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6
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Starke RM. Editorial. Assessment of the natural history of cerebral aneurysms in the setting of competing risk. J Neurosurg 2020; 132:1059-1061. [DOI: 10.3171/2018.12.jns183135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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7
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Tsunoda S, Yoshikawa G, Ishikawa O. One-stage Operation with Ipsilateral Two-Piece Craniotomies for a Case of Subarachnoid Hemorrhage with Multiple Intracranial Aneurysms. Asian J Neurosurg 2020; 14:1226-1230. [PMID: 31903368 PMCID: PMC6896625 DOI: 10.4103/ajns.ajns_165_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) with multiple intracranial aneurysms is common, but the difficulties often arise in determining treatment strategy in the acute phase. We experienced a case of SAH with distal anterior cerebral artery aneurysm coexisting with middle cerebral artery and anterior communicating artery aneurysms, in which it was difficult to identify the precise rupture site preoperatively, and both pterional approach and interhemispheric approach were required in the acute phase of SAH. However, we could treat whole aneurysms in one stage and obtained an excellent outcome using our surgical procedure with ipsilateral frontotemporal and frontal parasagittal craniotomies through a single skin incision.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.,Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Osamu Ishikawa
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.,Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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8
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Withayasuk P, Churojana A, Songsaeng D, Aurboonyawat T, Chankaew E. Favorable Outcome of Endovascular Treatment for Intracranial Aneurysms: A Single-Center Study in Thailand. Asian J Neurosurg 2018; 13:721-729. [PMID: 30283534 PMCID: PMC6159055 DOI: 10.4103/ajns.ajns_70_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: The purpose of this study is to collect the information on patients with intracranial aneurysm (IA) receiving endovascular management in Siriraj Hospital, Mahidol University, Thailand. Materials and Methods: We retrospectively reviewed data from patients with IA who underwent endovascular treatment from January 1997 through July 2013. We collected patients’ demographic data including age, sex, clinical presentations, and aneurysmal profiles, as well as endovascular treatment technique, complications, angiographic results, and regrowth rate. Treatment results included success rate, clinical findings during follow-up, and regrowth rate. Results: We reviewed data from 497 patients with 636 aneurysms (female:male ratio, 1.9:1; age range, 15–90 years; mean age, 59.18 years) and 69% presented with rupture. One hundred and twenty patients with 127 aneurysms received endovascular treatment. The most common location for endovascular treatment was the posterior communicating artery (15.8%), and endovascular techniques were used most often for posterior circulation and paraclinoid aneurysms. The success rate was approximately 99.2% with a 16.5% regrowth rate and no rebleeding. Regrowth rate did not correlate with immediate postoperative angiographic findings. We encountered 23 complications (18.1%); most commonly, intra-procedural rupture (7/23). Good outcomes occurred in approximately 95.9% of the patients. Conclusions: The success rate for endovascular treatment was >90%. Regrowth rate and clinical outcomes were within standard limits. Posterior circulation and paraclinoid aneurysms were our main targets. We tended to use fewer devices and simpler techniques to secure ruptured IA; however, the regrowth rate was similar to that using device-assisted techniques in other studies. We found no significant factors affecting regrowth rate, including immediate posttreatment angiographic results.
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Affiliation(s)
- Pattarawit Withayasuk
- Department of Radiology, Interventional Neuroradiology Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anchalee Churojana
- Department of Radiology, Interventional Neuroradiology Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dittapong Songsaeng
- Department of Radiology, Interventional Neuroradiology Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Taweesak Aurboonyawat
- Department of Surgery, Neurosurgery Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekawut Chankaew
- Department of Surgery, Neurosurgery Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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9
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Ngoepe MN, Frangi AF, Byrne JV, Ventikos Y. Thrombosis in Cerebral Aneurysms and the Computational Modeling Thereof: A Review. Front Physiol 2018; 9:306. [PMID: 29670533 PMCID: PMC5893827 DOI: 10.3389/fphys.2018.00306] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/13/2018] [Indexed: 01/26/2023] Open
Abstract
Thrombosis is a condition closely related to cerebral aneurysms and controlled thrombosis is the main purpose of endovascular embolization treatment. The mechanisms governing thrombus initiation and evolution in cerebral aneurysms have not been fully elucidated and this presents challenges for interventional planning. Significant effort has been directed towards developing computational methods aimed at streamlining the interventional planning process for unruptured cerebral aneurysm treatment. Included in these methods are computational models of thrombus development following endovascular device placement. The main challenge with developing computational models for thrombosis in disease cases is that there exists a wide body of literature that addresses various aspects of the clotting process, but it may not be obvious what information is of direct consequence for what modeling purpose (e.g., for understanding the effect of endovascular therapies). The aim of this review is to present the information so it will be of benefit to the community attempting to model cerebral aneurysm thrombosis for interventional planning purposes, in a simplified yet appropriate manner. The paper begins by explaining current understanding of physiological coagulation and highlights the documented distinctions between the physiological process and cerebral aneurysm thrombosis. Clinical observations of thrombosis following endovascular device placement are then presented. This is followed by a section detailing the demands placed on computational models developed for interventional planning. Finally, existing computational models of thrombosis are presented. This last section begins with description and discussion of physiological computational clotting models, as they are of immense value in understanding how to construct a general computational model of clotting. This is then followed by a review of computational models of clotting in cerebral aneurysms, specifically. Even though some progress has been made towards computational predictions of thrombosis following device placement in cerebral aneurysms, many gaps still remain. Answering the key questions will require the combined efforts of the clinical, experimental and computational communities.
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Affiliation(s)
- Malebogo N Ngoepe
- Department of Mechanical Engineering, University of Cape Town, Cape Town, South Africa.,Centre for High Performance Computing, Council for Scientific and Industrial Research, Cape Town, South Africa.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Alejandro F Frangi
- Center for Computational Imaging and Simulation Technologies in Biomedicine, University of Sheffield, Sheffield, United Kingdom
| | - James V Byrne
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Yiannis Ventikos
- UCL Mechanical Engineering, University College London, London, United Kingdom
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Fatal Intracranial Aneurysms and Dissections Causing Subarachnoid Hemorrhage: An Epidemiological and Pathological Analysis of 607 Legal Autopsy Cases. J Stroke Cerebrovasc Dis 2018; 27:486-493. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/25/2017] [Accepted: 09/20/2017] [Indexed: 11/23/2022] Open
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11
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Wáng YXJ, Zhang L, Zhao L, He J, Zeng XJ, Liu H, Yang YJ, Ding SW, Xu ZF, He YM, Yang L, Sun L, Mu KJ, Wang BS, Xu XH, Ji ZY, Liu JH, Fang JZ, Hou R, Fan F, Peng GM, Zhu YQ, Ju SH, Poon WS. Elderly population have a decreased aneurysmal subarachnoid hemorrhage incidence rate than Middle aged population: a descriptive analysis of 8,144 cases in mainland China. Br J Neurosurg 2018; 32:165-171. [PMID: 29338437 DOI: 10.1080/02688697.2018.1426724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Lihong Zhang
- Hebei Medical University, The Second Affiliated Hospital, Shijiazhuang, Hebei Province, China
| | - Lin Zhao
- Hebei Medical University, The Second Affiliated Hospital, Shijiazhuang, Hebei Province, China
| | - Jian He
- Nanjing University, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Xian-Jun Zeng
- Nanchang University, The first Affiliated Hospital, Nanchang, Jiangxi Province, China
| | - Heng Liu
- Zunyi Medical University Hospital, Zunyi, Guizhou Province, China
| | - Yun-Jun Yang
- Wenzhou Medical University, The First Affiliated Hospital, Wenzhou, Zhejiang Province, China
| | - Shang-Wei Ding
- Dongguan People's Hospital, Teaching Hospital of Southern Medical University, Dongguan, Guangdong Province, China
| | - Zhong-Fei Xu
- Taizhou Central People’s Hospital & Teaching Hospital of Taizhou College, Jiaojiang, Zhejiang Province, China
| | - Yong-Ming He
- Soochow University, The First Affiliated Hospital, Suzhou, Jiangsu Province, China
| | - Lin Yang
- North Sichuan Medical College Hospital, Nanchong, Sichuan Province, China
| | - Lan Sun
- The People’s Hospital of Bishan District, Chongqing, China
| | - Ke-Jie Mu
- The People’s Hospital of Bishan District, Chongqing, China
| | - Bai-Song Wang
- Shaoxing Hospital, Teaching Hospital of China Medical University, Keqiao, Zhejiang Province, China
| | - Xiao-Hong Xu
- Guangdong Medical University Hospital, Zhanjiang, Guangdong Province, China
| | - Zhong-You Ji
- Fujian Medical University, Union Hospital, Fuzhou, Fujian Province, China
| | - Jian-Hua Liu
- The first People’s Hospital of Guangzhou City, Guangzhou, Guangdong Province, China
| | - Jin-Zhou Fang
- Hospital of Juhua Group Corporation, Quzhou, Zhejiang Province, China
| | - Rui Hou
- The Central People’s Hospital of Siping City, Siping, Jilin Province, China
| | - Feng Fan
- Zhengzhou University, The First Affiliated Hospital, Zhengzhou, Henan Province, China
| | - Guang-Ming Peng
- The General Hospital of Guangzhou Military Command, Guangzhou, Guangdong Province, China
| | - Yue-Qi Zhu
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Sheng-Hong Ju
- Southeast University, Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Wai S. Poon
- Division of Neurosurgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
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12
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Nakai Y, Hamada H, Kittaka D, Noda C, Sato H, Kato K. [Standardization of Analysis Conditions and Prediction of Increase Prediction Using Blood Flow Analysis Software for Cerebral Aneurysms: Phantom Study and Clinical Study]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:1275-1285. [PMID: 30464095 DOI: 10.6009/jjrt.2018_jsrt_74.11.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In recent years, reports have been made that predict the state of aneurysm by performing computational fluid dynamics (CFD) analysis using cerebral aneurysm blood flow analysis software. However, analysis results are not constant and there are various opinions, and it is conceivable that the image quality and analysis conditions of medical images used for CFD analysis are not standardized. In this study, CFD analysis of cerebral aneurysm phantom was performed, and image quality and analysis conditions were standardized. Then, we investigated whether increase of cerebral aneurysm and prediction of rupture are possible. From this study, stable results of wall shear stress analysis were obtained under slice thickness 1.0 mm or less, CT value 400 HU or more, reconstruction function as soft part function, image SD under 10 HU. In addition, as the size of the cerebral aneurysm became larger, wall shear stress tended to be lower, and the same tendency was shown also in clinical cases. Although CFD analysis using software dedicated to blood flow analysis did not reach the prediction of rupture, it can be evaluated based on the quantitative values for the aneurysm increase at the preceding stage and plays an important role in prediction there is a possibility.
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Affiliation(s)
- Yuichi Nakai
- Department of Radiological Technology, Showa University Northern Yokohama Hospital
| | - Hiroki Hamada
- Department of Radiological Technology, Showa University Hospital
| | - Daisuke Kittaka
- Department of Radiological Technology, Showa University Hospital
| | - Chikara Noda
- Department of Radiological Technology, Showa University Northern Yokohama Hospital
- Graduate School of Health Sciences, Showa University
| | - Hisaya Sato
- Department of Radiological Technology, Showa University Hospital
- Graduate School of Health Sciences, Showa University
| | - Kyoichi Kato
- Graduate School of Health Sciences, Showa University
- Department of Unification Radiological Technology, Showa University
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13
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Cai W, Hu C, Gong J, Lan Q. Anterior Communicating Artery Aneurysm Morphology and the Risk of Rupture. World Neurosurg 2017; 109:119-126. [PMID: 28958928 DOI: 10.1016/j.wneu.2017.09.118] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, with improvements in computed tomography angiography and digital subtraction angiography, the assessment of certain morphologic traits of anterior communicating artery aneurysms (ACoAA) has drawn great attention. The determination of specific factors associated with rupture would provide much-needed guidance for the treatment of unruptured intracranial aneurysms, such as surgical clipping or endovascular coiling. Morphologic factors include, but are not limited to, aneurysm size, number, shape, dome direction, neck/dome ratio, and relationship of the aneurysm to the surrounding vessels. However, the results of previous investigations concerning morphologic parameters have yielded inconsistent results. METHODS This review presents and analyzes the literature on the morphology of ACoAAs and risk of rupture. RESULTS This literature review reveals that the strongest predictors of ACoAA rupture are size ratio, direction of the dome, and fenestration. These were the only factors that were either unanimously or near unanimously found to be predictive of rupture across multiple studies. CONCLUSIONS The size ratio, direction of the dome, and fenestration should be examined most meticulously when deciding when to treat an ACoAA.
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Affiliation(s)
- Wu Cai
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China; Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Chunhong Hu
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
| | - Jianping Gong
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Qing Lan
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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14
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Hokari M, Nakayama N, Shimoda Y, Houkin K. Effect of Headache on the Pathologic Findings of Unruptured Cerebral Saccular Aneurysms. World Neurosurg 2017; 103:431-441. [PMID: 28427983 DOI: 10.1016/j.wneu.2017.01.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Some patients with aneurysm exhibit warning headaches without minor bleeding, and this could be caused by stretching of the aneurysm wall. Recently, our pathologic study observed subintimal fibrin deposition in a majority of the ruptured aneurysms. However, these findings also were observed in some unruptured aneurysms. In this report, 2 unruptured aneurysms exhibited subintimal fibrin, and interestingly, one of the patients experienced severe headache within 1 month before neuroimaging. OBJECTIVE We performed pathologic analysis of unruptured aneurysms and collected their various clinical variables, including severe headache, to clarify the clinical characteristics of "dangerous" unruptured aneurysms. METHODS This study included unruptured saccular aneurysm samples (n = 17) that were resected after clipping. We compared the differences in clinical variables, including warning headache, between aneurysms with and without fibrin deposition. RESULTS Fibrin deposition was present in the subintimal layer in 4 patients and in the periouter membrane in 4 patients. Three of the 4 former patients experienced warning headaches, and one presented aneurysm growth. Of the latter 4 patients, one exhibited aneurysm growth, whereas the others presented with relatively large aneurysms. In the remaining 9 aneurysms without fibrin deposition, monocyte infiltration was observed in one, all aneurysms were small, and no patients experienced warning headaches or aneurysm growth. CONCLUSIONS Subintimal fibrin deposition is observed frequently in patients with aneurysm with warning headaches. These pathologic findings are clinically inspiring and may suggest that these aneurysms exhibit rapid stretching by newly formed aneurysms, which can result in rupture at an early stage.
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Affiliation(s)
- Masaaki Hokari
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yusuke Shimoda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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15
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Abboud T, Rustom J, Bester M, Czorlich P, Vittorazzi E, Pinnschmidt HO, Westphal M, Regelsberger J. Morphology of Ruptured and Unruptured Intracranial Aneurysms. World Neurosurg 2016; 99:610-617. [PMID: 28017741 DOI: 10.1016/j.wneu.2016.12.053] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In addition to size and location, the morphology of intracranial aneurysms has been proposed to predict rupture. This study was undertaken to compare morphologic features between ruptured and unruptured aneurysms and identify those associated with greater risk of rupture. METHODS Between 2010 and 2014, 301 patients with subarachnoid hemorrhage and 204 with unruptured aneurysms were admitted to our hospital. Two investigators reviewed 3-dimensional angiograms of all aneurysms. Risk factors for rupture were identified. Morphology was classified into single-sac aneurysms with smooth margin, single-sac aneurysms with irregular margin, aneurysms with a daughter sac, and multilobulated aneurysms. The value of morphology in predicting rupture was tested with the use of logistic regression. RESULTS A total of 420 aneurysms met the inclusion criteria. Multilobulated aneurysm was the most frequent finding among ruptured aneurysms, followed by single sac with irregular margin, aneurysm with daughter sac, and single sac with smooth margin (44.9%, 25.9%, 18%, and 11.2%, respectively). Among unruptured aneurysms, single sac with smooth margin was the most frequent finding, followed by single sac with irregular margin, multilobulated aneurysm, and aneurysm with daughter sac (38.1%, 29.8%, 20.9%, and 11.2%, respectively). Morphology was an independent predictor of rupture (receiver operating characteristic-area under the curve 0.693, P < 0.001). Risk of rupture increased by factor of 3 (5, 95% confidence interval [CI] 1.6-5.3) from single sac with regular margin to irregular margin, by factor of 5.5 (5, 95% CI 2.8-11.0) to daughter sac, and by factor of 7.3 (5, 95% CI 4.1-13.1) to multilobulated aneurysm. CONCLUSIONS Morphology might have an independent predictive value of aneurysm rupture. Risk of rupture might increase according to extent of morphologic change. Prospective studies will be necessary to evaluate the influence of aneurysm morphology on natural history.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jihad Rustom
- Department of Internal Medicine, Klinikum Itzehoe, Itzehoe, Germany
| | - Maxim Bester
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vittorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Tanaka H, Katsuragi S, Tanaka K, Iwanaga N, Yoshimatsu J, Takahashi JC, Ikeda T. Impact of pregnancy on the size of small cerebral aneurysm. J Matern Fetal Neonatal Med 2016; 30:2759-2762. [PMID: 27852140 DOI: 10.1080/14767058.2016.1262345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Because the management of cerebral aneurysms during pregnancy remains controversial, the objective of this study was to perform a retrospective review of pregnant women with cerebral aneurysms to determine whether pregnancy is a risk factor for aneurysm rupture. METHODS The change in size of aneurysms during pregnancy was examined by performing repeat magnetic resonance angiography in five pregnant women with cerebral aneurysms between 2005 and 2013. The outcome examined was development of subarachnoid hemorrhage. RESULTS Among the five pregnancies, there were eight cerebral aneurysms. Subarachnoid hemorrhage did not developed during any pregnancy. In four of the pregnancies, the cerebral aneurysms did not change in size during pregnancy, remaining 2-5 mm. Although in one pregnancy, the aneurysm increased from 6 to 7 mm during the third trimester, it returned to its original size in the postpartum period. CONCLUSIONS We suggest that if the cerebral aneurysm is small (≤ 5 mm), it is likely to remain unchanged despite the increase in circulating blood volume during pregnancy. Cerebral aneurysms greater than 5 mm but without blebs, irregular shape, high-risk location, or increased aspect ratio are also at low risk of rupture and are not likely to change during pregnancy.
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Affiliation(s)
- Hiroaki Tanaka
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan.,b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Shinji Katsuragi
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Kayo Tanaka
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan.,b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Naoko Iwanaga
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Jun Yoshimatsu
- a Department of Perinatology and Gynecology , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Jun C Takahashi
- c Department of Neurosugery , National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Tomoaki Ikeda
- b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
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17
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Regional Mapping of Flow and Wall Characteristics of Intracranial Aneurysms. Ann Biomed Eng 2016; 44:3553-3567. [PMID: 27350071 PMCID: PMC5114167 DOI: 10.1007/s10439-016-1682-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
The evolution of intracranial aneurysms (IAs) is thought to be driven by progressive wall degradation in response to abnormal hemodynamics. Previous studies focused on the relationship between global hemodynamics and wall properties. However, hemodynamics, wall structure and mechanical properties of cerebral aneurysms can be non-uniform across the aneurysm wall. Therefore, the aim of this work is to introduce a methodology for mapping local hemodynamics to local wall structure in resected aneurysm specimens. This methodology combines image-based computational fluid dynamics, tissue resection, micro-CT imaging of resected specimens mounted on 3D-printed aneurysm models, alignment to 3D vascular models, multi-photon microscopy of the wall, and regional mapping of hemodynamics and wall properties. This approach employs a new 3D virtual marking tool for surgeons to delineate the location of the resected specimen directly on the 3D model, while in the surgical suite. The case of a middle cerebral artery aneurysm is used to illustrate the application of this methodology to the assessment of the relationship between local wall shear stress and local wall properties including collagen fiber organization and wall geometry. This methodology can similarly be used to study the relationship between local intramural stresses and local wall structure.
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18
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Swartbooi A, Meyer C, De Vries C. Digital subtraction angiography findings and population demographics of patients with subarachnoidal haemorrhage and subsequent causative aneurysms at Universitas Academic Hospital, Bloemfontein. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Subarachnoid haemorrhage (SAH) secondary to aneurysmal rupture may be associated with serious neurological sequelae or even mortality. According to international literature, only aneurysms >7 mm or aneurysms in the posterior circulation require treatment. Retrospective single-centre studies have, however, disputed this after demonstrating that the average size of ruptured aneurysms are <7 mm. More recent guidelines place less emphasis on size and more on associated risk factors.Objectives: The aim of this investigation was to assess the aneurysm characteristics and demographics of patients who presented to our institution with SAH secondary to an aneurysm detected at digital subtraction angiography (DSA).Method: A retrospective descriptive study was conducted. Patients who presented with SAH over a 6-year period, from 2008 to 2013, were included. The average size of the intracranial aneurysms at the time of rupture was analysed. Data about aneurysm characteristics and patient demographics were obtained from patient files. Data were analysed by the researchers with assistance from the Department of Biostatistics.Results: In total, 161 of 374 patients who underwent DSA had ruptured aneurysms. Most patients were women with ages ranging from 18 to 73 years (mean 45 years). The mean size of aneurysms were 5.8 mm (range 1.2 mm – 20 mm), with 74.5% of aneurysms <7 mm. Most aneurysms were noted involving the anterior circulation (72%), with the majority arising from the anterior communicating artery (36.7%).Conclusion: We found that aneurysms rupture at sizes <7 mm and are commonly located in the anterior circulation. Our findings emphasise the importance of conducting institutional reviews to consider adapting international treatment guidelines for the local South African situation.
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19
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Abstract
Intracranial aneurysms (IAs) have an estimated incidence of up to 10 % and can lead to serious morbidity and mortality. Because of this, the natural history of IAs has been studied extensively, with rupture rates ranging from 0.5 to 7 %, depending on aneurysm characteristics. The spectrum of presentation of IAs ranges from incidental detection to devastating subarachnoid hemorrhage. Although the gold standard imaging technique is intra-arterial digital subtraction angiography, other modalities such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are being increasingly used for screening and treatment planning. Management of these patients depends upon a number of factors including aneurysmal, patient, institutional, and operator factors. The ultimate goal of treating patients with IAs is complete and permanent occlusion of the aneurysm sac in order to eliminate future hemorrhagic risk, while preserving or restoring the patient's neurological function. The most common treatment approaches include microsurgical clipping and endovascular coiling, and multiple studies have compared these two techniques. To date, three large prospective, randomized studies have been done: a study from Finland, International Subarachnoid Aneurysm Trial (ISAT), and the Barrow Ruptured Aneurysm Trial (BRAT). Despite differences in methodology, the results were similar: in patients undergoing coiling, although rates of rebleeding and retreatment are higher, the overall rate of poor outcomes at 12 months was significantly lower. As minimally invasive procedures and devices continue to be refined, endovascular strategies are likely to increase in popularity. However, as long-term outcome studies become available, it is increasingly apparent that they are complementary treatment strategies, with patient selection of critical importance.
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Affiliation(s)
- Ann Liu
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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20
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A 54-year-old man with 12 intracranial aneurysms and familial subarachnoid hemorrhage: case report. Neurosurg Rev 2016; 39:711-6. [PMID: 27452953 DOI: 10.1007/s10143-016-0769-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/01/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
Unruptured intracranial aneurysms occur in 1-3 % of the general population, and the risk of rupture is generally considered to be low. However, patients with multiple aneurysms and familial predisposition carry a particular risk of subarachnoid hemorrhage (SAH). A 54-year-old hypertensive man underwent screening with a head CT angiography (CTA) because of his comorbidities. CTA revealed multiple bilateral aneurysms around the circle of Willis. At first surgery, seven aneurysms were clipped (BA, ACOM, ICA ×2, and MCA ×3), two of which were detected intraoperatively only. During the second surgery, another three aneurysms were surgically clipped (PCOM and MCA ×2), one of which was detected intraoperatively. Follow-up angiography revealed another two aneurysms. A PCOM aneurysm was treated by coil embolization and a VA aneurysm clipped surgically during a third admission. The patient made an uneventful recovery. However, 4 months after his second surgery, his daughter underwent surgical clipping of a right-sided ICA aneurysm. This case report highlights both the importance of screening of high risk patients with family history of SAH, as well as its limitations, as our patient developed two de novo aneurysms during 6-month follow-up and CTA preoperatively missed three small aneurysms.
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21
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Matsukawa H, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Takahashi O, Tokuda S, Tanikawa R. Is Age a Risk Factor for Poor Outcome of Surgical Treatment of Unruptured Intracranial Aneurysms? World Neurosurg 2016; 94:222-228. [PMID: 27392889 DOI: 10.1016/j.wneu.2016.06.118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Advanced age is known to be a significant risk factor for the rupture of intracranial aneurysms. The impact of age on outcomes of surgically treated patients with unruptured intracranial aneurysms (UIAs) is less clear. METHODS A total of 663 consecutive patients with 823 surgically treated UIAs were evaluated. UIAs, which need bypass surgery including low-flow or high-flow bypass, were defined as complex aneurysms. Aneurysm size was categorized as small (<15 mm), large (15-24 mm), and giant (≥25 mm). In patients without symptoms, a poor outcome is defined as a modified Rankin Scale (mRS) score of 2-6. In those with mRS score higher than 1 as a result of UIA-related symptoms or other comorbidities, a poor outcome is defined as an increase of 1 or more on the mRS. Outcomes were evaluated at the 6-month and 12-month follow-up examinations. RESULTS The mean age was 62 ± 12 years and 650 UIAs (78%) were observed in women. Previously treated aneurysm (P = 0.009), posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.011), and perforator territory infarction (P < 0.0001) were related to poor outcome at 6 months, and posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.035), and perforator territory infarction (P = 0.013) were related to poor outcome at 12 months. Age was not associated with poor outcome in patients with UIAs who undertook direct surgery. CONCLUSIONS Although risks and benefits of aneurysm treatment in older patients should be carefully considered, surgical treatment of UIAs in the elderly should be considered positively.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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22
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Qian Z, Kang H, Tang K, Jiang C, Wu Z, Li Y, Liu A. Assessment of Risk of Aneurysmal Rupture in Patients with Normotensives, Controlled Hypertension, and Uncontrolled Hypertension. J Stroke Cerebrovasc Dis 2016; 25:1746-1752. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/14/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022] Open
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23
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Bourcier R, Lenoble C, Guyomarch-Delasalle B, Daumas-Duport B, Papagiannaki C, Redon R, Desal H. Is there an inherited anatomical conformation favoring aneurysmal formation of the anterior communicating artery? J Neurosurg 2016; 126:1598-1605. [PMID: 27315030 DOI: 10.3171/2016.4.jns153032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated with the presence of anterior communicating artery (ACoA) aneurysms in the familial forms of IAs. METHODS This multicenter study investigated bifurcation IAs in patients who had a sporadic ACoA IA without a family history of IA (SACAA group), in patients who had an ACoA IA with a family history of IA (FACAA group), and in their healthy first-degree relatives (HFDRs). Through the use of MR angiography (MRA) reconstructions, the symmetry of the A1 segments and the angle between the A1 and A2 segments were analyzed on 3D models for each group. These measurements were then compared among the 3 groups. RESULTS Twenty-four patients with SACAA, 24 patients with FACAA, and 20 HFDRs were included in the study. Asymmetrical configuration of the A1 segments was more frequent in the FACAA group than in the HFDR group (p = 0.002). The aneurysm-side A1-A2 angle was lower in the FACAA group (p = 0.003) and SACAA group (p = 0.007) than in the HFDR group. On the contralateral side, there was no difference in A1-A2 angles between groups. CONCLUSIONS The anatomical shape of the ACoA complex seems to be similarly associated with the presence of ACoA IAs in both the FACAA and SACAA groups. This highlights the role played by hemodynamic constraints in aneurysm formation and questions the hypothesis of the hereditary character of these anatomical shapes.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.,CNRS, UMR 6291, Université de Nantes, Nantes; and
| | - Cédric Lenoble
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec
| | | | - Benjamin Daumas-Duport
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec
| | | | - Richard Redon
- INSERM, UMR1087, l'institut du thorax, CHU de Nantes.,CNRS, UMR 6291, Université de Nantes, Nantes; and
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.,CNRS, UMR 6291, Université de Nantes, Nantes; and
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24
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Radiologic Surveillance of Untreated Unruptured Intracranial Aneurysms: A Single Surgeon's Experience. World Neurosurg 2016; 90:20-28. [DOI: 10.1016/j.wneu.2016.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/20/2022]
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25
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Are Morphologic Parameters Actually Correlated with the Rupture Status of Anterior Communicating Artery Aneurysms? World Neurosurg 2015; 84:1278-83. [DOI: 10.1016/j.wneu.2015.05.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 11/19/2022]
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26
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Vanrossomme AE, Eker OF, Thiran JP, Courbebaisse GP, Zouaoui Boudjeltia K. Intracranial Aneurysms: Wall Motion Analysis for Prediction of Rupture. AJNR Am J Neuroradiol 2015; 36:1796-802. [PMID: 25929878 PMCID: PMC7965030 DOI: 10.3174/ajnr.a4310] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Intracranial aneurysms are a common pathologic condition with a potential severe complication: rupture. Effective treatment options exist, neurosurgical clipping and endovascular techniques, but guidelines for treatment are unclear and focus mainly on patient age, aneurysm size, and localization. New criteria to define the risk of rupture are needed to refine these guidelines. One potential candidate is aneurysm wall motion, known to be associated with rupture but difficult to detect and quantify. We review what is known about the association between aneurysm wall motion and rupture, which structural changes may explain wall motion patterns, and available imaging techniques able to analyze wall motion.
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Affiliation(s)
- A E Vanrossomme
- From the Laboratory of Experimental Medicine (A.E.V., K.Z.B.), Université Libre de Bruxelles, Bruxelles, Belgium
| | - O F Eker
- Department of Interventional Neuroradiology (O.F.E.), Gui de Chauillac Hospital, Centre Hospitalier Régional Universitaire Montpellier, Montpellier, France
| | - J-P Thiran
- Signal Processing Laboratory (J.-P.T.), Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland Department of Radiology (J.-P.T.), University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - G P Courbebaisse
- Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé - Centre National de Recherche Scientifique - Unité Mixte de Recherche 5220 (G.P.C.), Institut National des Sciences Appliquées Lyon, Université de Lyon, Lyon, France
| | - K Zouaoui Boudjeltia
- From the Laboratory of Experimental Medicine (A.E.V., K.Z.B.), Université Libre de Bruxelles, Bruxelles, Belgium
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27
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Krishna C, Sonig A, Natarajan SK, Siddiqui AH. The expanding realm of endovascular neurosurgery: flow diversion for cerebral aneurysm management. Methodist Debakey Cardiovasc J 2015; 10:214-9. [PMID: 25624975 DOI: 10.14797/mdcj-10-4-214] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The worldwide prevalence of intracranial aneurysms is estimated to be between 5% and 10%, with some demographic variance. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm results in devastating neurological outcomes, leaving the majority of victims dead or disabled. Surgical clipping of intracranial aneurysms remained the definitive mode of treatment until Guglielmi detachable coils were introduced in the 1990s. This revolutionary innovation led to the recognition of neurointervention/neuroendovascular surgery as a bona fide option for intracranial aneurysms. Constant evolution of endovascular devices and techniques supported by several prospective randomized trials has catapulted the endovascular treatment of intracranial aneurysms to its current status as the preferred treatment modality for most ruptured and unruptured intracranial aneurysms. We are slowly transitioning from the era of coils to the era of flow diverters. Flow-diversion technology and techniques have revolutionized the treatment of wide-necked, giant, and fusiform aneurysms, where the results of microsurgery or conventional neuroendovascular strategies have traditionally been dismal. Although the Pipeline Embolization Device (ev3-Covidien, Irvine, CA) is the only flow-diversion device approved by the Food and Drug Administration for use in the United States, others are commercially available in Europe and South America, including the Silk (Balt Extrusion, Montmorency, France), Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, CA), Surpass (Stryker, Kalamazoo, MI), and p64 (Phenox, Bochum, Germany). Improvements in technology and operator experience and the encouraging results of clinical trials have led to broader acceptance for the use of these devices in cerebral aneurysm management. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden the endovascular therapeutic spectrum for varied aneurysm morphology.
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Affiliation(s)
- Chandan Krishna
- University at Buffalo, State University of New York, Buffalo, New York ; Gates Vascular Institute/Kaleida Health, Buffalo, New York
| | - Ashish Sonig
- University at Buffalo, State University of New York, Buffalo, New York ; Gates Vascular Institute/Kaleida Health, Buffalo, New York
| | - Sabareesh K Natarajan
- University at Buffalo, State University of New York, Buffalo, New York ; Gates Vascular Institute/Kaleida Health, Buffalo, New York
| | - Adnan H Siddiqui
- University at Buffalo, State University of New York, Buffalo, New York ; Jacobs Institute, Buffalo, New York
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28
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Robertson AM, Duan X, Aziz KM, Hill MR, Watkins SC, Cebral JR. Diversity in the Strength and Structure of Unruptured Cerebral Aneurysms. Ann Biomed Eng 2015; 43:1502-15. [PMID: 25632891 PMCID: PMC4497939 DOI: 10.1007/s10439-015-1252-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/13/2015] [Indexed: 11/28/2022]
Abstract
Intracranial aneurysms are pathological enlargements of brain arteries that are believed to arise from progressive wall degeneration and remodeling. Earlier work using classical histological approaches identified variability in cerebral aneurysm mural content, ranging from layered walls with intact endothelium and aligned smooth muscle cells, to thin, hypocellular walls. Here, we take advantage of recent advances in multiphoton microscopy, to provide novel results for collagen fiber architecture in 15 human aneurysm domes without staining or fixation as well as in 12 control cerebral arteries. For all aneurysm samples, the elastic lamina was absent and the abluminal collagen fibers had similar diameters to control arteries. In contrast, the collagen fibers on the luminal side showed great variability in both diameter and architecture ranging from dense fiber layers to sparse fiber constructs suggestive of ineffective remodeling efforts. The mechanical integrity of eight aneurysm samples was assessed using uniaxial experiments, revealing two sub-classes (i) vulnerable unruptured aneurysms (low failure stress and failure pressure), and (ii) strong unruptured aneurysms (high failure stress and failure pressure). These results suggest a need to refine the end-point of risk assessment studies that currently do not distinguish risk levels among unruptured aneurysms. We propose that a measure of wall integrity that identifies this vulnerable wall subpopulation will be useful for interpreting future biological and structural data.
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Affiliation(s)
- Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA,
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Bourcier R, Redon R, Desal H. Genetic investigations on intracranial aneurysm: update and perspectives. J Neuroradiol 2015; 42:67-71. [PMID: 25676693 DOI: 10.1016/j.neurad.2015.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/26/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
Detection of an intracranial aneurysm (IA) is a common finding in MRI practice. Nowadays, the incidence of unruptured IA seems to be increasing with the continuous evolution of imaging techniques. Important modifiable risk factors for SAH are well defined, but familial history of IA is the best risk marker for the presence of IA. Numerous heritable conditions are associated with IA formation but these syndromes account for less than 1% of all IAs in the population. No diagnostic test based on genetic knowledge is currently available to identify theses mutations and patients who are at higher risk for developing IAs. In the longer term, a more comprehensive understanding of independent and interdependent molecular pathways germane to IA formation and rupture may guide the physician in developing targeted therapies and optimizing prognostic risk assessment.
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Affiliation(s)
- Romain Bourcier
- Department of neuroradiology, CHU Nantes, boulevard J.-Monod, 44000 Nantes, France; 1087 Inserm unit, institut du thorax, 44000 Nantes, France.
| | - Richard Redon
- 1087 Inserm unit, institut du thorax, 44000 Nantes, France
| | - Hubert Desal
- Department of neuroradiology, CHU Nantes, boulevard J.-Monod, 44000 Nantes, France; 1087 Inserm unit, institut du thorax, 44000 Nantes, France
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Suzuki M, Yoneda H, Ishihara H, Shirao S, Nomura S, Koizumi H, Suehiro E, Goto H, Sadahiro H, Maruta Y, Inoue T, Oka F. Adverse events after unruptured cerebral aneurysm treatment: a single-center experience with clipping/coil embolization combined units. J Stroke Cerebrovasc Dis 2014; 24:223-31. [PMID: 25440336 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/14/2014] [Accepted: 08/22/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Indications of clipping (Clip) or coil embolization (Coil) for unruptured cerebral aneurysms (uAN) was not elaborated because prediction of rupture and risk of treatment are difficult. This study aims to determine the risk-benefit analysis of treating uAN by a comprehensive and retrospective investigation of the adverse events and sequelae in patients treated by our Clip/Coil combined units. METHODS Clip and Coil were performed in 141 and 80 patients, respectively; Clip for middle cerebral artery AN and Coil for paraclinoid or basilar apex AN. Worsening of modified Rankin scale or mini-mental state examination was defined as major morbidity. Minor morbidity or transient morbidity was defined as other neurologic deficits. Mortality and these morbidities were considered as serious adverse events. Convulsion or events outside the brain were defined as mild adverse events. RESULTS Total mortality and major morbidity were low. Incidence of serious adverse events was not significantly different between the Clip and Coil (17 patients [12.1%] and 6 patients [7.5%]), but the number of total adverse events was significantly different (32 patients [22.7%] in Clip vs. 8 patients [10.0%] in Coil). Because mild morbidities were significantly more frequent in the Clip (20 patients [14.2%]) compared with the Coil (2 patients [2.5%]). Convulsion occurred in 11 (7.8%) patients in the Clip but none in the Coil. CONCLUSIONS Our combined unit decreased the occurrence of mortality/major morbidity; however, minor adverse effects were common, especially in the Clip group because of many intrinsic problems of Clip itself. This result suggests further consideration for the treatment modality for uAN.
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Affiliation(s)
- Michiyasu Suzuki
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
| | - Hiroshi Yoneda
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Satoshi Shirao
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Sadahiro Nomura
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroyasu Koizumi
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Eiichi Suehiro
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hisaharu Goto
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hirokazu Sadahiro
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yuichi Maruta
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takao Inoue
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Fumiaki Oka
- Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Uncertainty in patients with unruptured intracranial aneurysms undergoing endovascular surgery: a qualitative and inductive study. Nurs Res 2014; 63:366-74. [PMID: 25171562 DOI: 10.1097/nnr.0000000000000050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advances in diagnostic imaging technology have increased opportunities to discover unruptured intracranial aneurysms (UIA), and prior research has shown that UIA patients experience uncertainty both when making choices regarding treatment and after surgery. OBJECTIVES The purpose of this study was to clarify the nature of the uncertainty experienced by UIA patients who elect to undergo endovascular surgery. METHODS Data from interviews with 31 subjects were synthesized with findings from previous research and then analyzed qualitatively and inductively. RESULTS Six categories were derived from the analysis to describe the uncertainty experienced by UIA patients who undergo intravascular surgery: Nature of the Disease, Treatment Characteristics, Information, Decision-making, Course of the Future, and Living with UIA. DISCUSSION The Treatment Characteristics and Decision-making categories reflect new aspects of uncertainty arising from advances in diagnostic imaging and appeared specific to patients with UIA. This suggests a need to select appropriate nursing methods adapted to the situation of each patient that can both reduce and manage their uncertainty. Developing an uncertainty scale for UIA patients based on the structural concepts clarified in this study and investigating reliability and validity of scores are topics for future research.
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Jeong HW, Seo JH, Kim ST, Jung CK, Suh SI. Clinical practice guideline for the management of intracranial aneurysms. Neurointervention 2014; 9:63-71. [PMID: 25426300 PMCID: PMC4239410 DOI: 10.5469/neuroint.2014.9.2.63] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022] Open
Abstract
Purpose An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. Materials and Methods We performed an extensive literature search, using Medline. We met in person to discuss recommendations. This document is reviewed by the Task Force Team of the Korean Society of Interventional Neuroradiology (KSIN). Results We divided the current guideline for ruptured intracranial aneurysms (RIAs) and unruptured intracranial aneurysms (UIAs). The guideline for RIAs focuses on diagnosis and treatment. And the guideline for UIAs focuses on the definition of a high-risk patient, screening, principle for treatment and selection of treatment method. Conclusion This guideline provides practical, evidence-based advice for the management of patients with an intracranial aneurysm, with or without rupture.
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Affiliation(s)
- Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, Busan, Korea
| | - Cheol Kyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
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Kubo Y, Koji T, Kashimura H, Otawara Y, Ogawa A, Ogasawara K. Female sex as a risk factor for the growth of asymptomatic unruptured cerebral saccular aneurysms in elderly patients. J Neurosurg 2014; 121:599-604. [DOI: 10.3171/2014.5.jns132048] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Object
The prevalence of patients with asymptomatic unruptured intracranial aneurysms (UIAs) increases with the advancing age of the general population. The goal of the present study was to identify risk factors for the growth of UIAs detected with serial MR angiography (MRA) in patients 70 years of age or older.
Methods
This prospective study enrolled 79 patients (age range 70–84 years) with 98 UIAs. Patients were followed up every 4 months, including an assessment of the aneurysm diameter and morphological changes on MRA, neurological status, and other medical conditions. Aneurysm growth was categorized into two different patterns on the basis of the MRA findings: 1) maximum increase in aneurysm diameter of 2 mm or more; and 2) obvious morphological change, such as the appearance of a bleb.
Results
The mean duration of follow-up was 38.5 months (250.2 patient-years). Aneurysm rupture did not occur, but aneurysm growth was observed in 8 aneurysms (8 patients) during the study period. Univariate analysis showed that female sex, patient age ≥ 75 years, and an aneurysm location in the internal carotid artery (ICA) or middle cerebral artery (MCA) were associated with aneurysm growth (p = 0.04, p = 0.04, and p < 0.001, respectively). Multivariate analysis demonstrated that female sex was the only independent predictor of aneurysm growth (p = 0.0313, OR 2.3, 95% CI 1.3–30.2).
Conclusions
Female sex is an independent risk factor for the growth of UIAs in elderly patients. In addition, an age ≥ 75 years and aneurysm location in the ICA or MCA are characteristics that may warrant additional attention during follow-up imaging.
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Xiang J, Yu J, Choi H, Dolan Fox JM, Snyder KV, Levy EI, Siddiqui AH, Meng H. Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic-morphological discriminants. J Neurointerv Surg 2014; 7:490-5. [PMID: 24811740 DOI: 10.1136/neurintsurg-2014-011218] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/24/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We have previously developed three logistic regression models for discriminating intracranial aneurysm rupture status from 119 aneurysms based on hemodynamic-morphological parameters. In this study we exploit their use as a tool for predicting the risk of rupture of aneurysms with a defined Rupture Resemblance Score (RRS). METHODS We collected three-dimensional images of 85 consecutive aneurysms, applied the three regression models and compared model performance at predicting rupture status against anecdotal metrics (aneurysm size and aspect ratio). We then reinterpreted the model-predicted probability as RRS, where the higher the score the closer the resemblance to previously known rupture components, and applied the RRS prospectively to four unruptured aneurysms with borderline treatment decisions. RESULTS All three models yielded excellent sensitivity (0.78-0.83) and specificity (0.78-0.84) at a cutoff score of 50%, whereas aneurysm size and aspect ratio showed poor sensitivities (0.28 and 0.33, respectively). Lowering the cutoff score to 30% improved sensitivity to 0.90. The RRS identified most of the ruptured aneurysms and also some unruptured ones that closely resembled ruptured aneurysms hemodynamically and/or morphologically. The prospective application of the RRS to unruptured aneurysms shows that it could provide additional insights for treatment decisions. CONCLUSIONS Previous regression models based on hemodynamic-morphological parameters are able to discriminate rupture in a new cohort in the same population. A higher probability of rupture is associated with larger size ratio, lower normalized wall shear stress and higher oscillatory shear index. The RRS could potentially stratify rupture risk and assist in treatment decision-making for unruptured aneurysms.
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Affiliation(s)
- Jianping Xiang
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jihnhee Yu
- Department of Biostatistics, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Hoon Choi
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, Upstate Medical University, Syracuse, New York, USA
| | - Jennifer M Dolan Fox
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Kenneth V Snyder
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Radiology, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Elad I Levy
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Radiology, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Radiology, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Coil embolization of overwide and undertall small intracranial aneurysms with double microcatheter technique. Acta Neurochir (Wien) 2014; 156:839-46. [PMID: 24639146 DOI: 10.1007/s00701-014-2049-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Overwide and undertall small intracranial aneurysms remain a challenge for coil embolization. The purpose of this study is to evaluate the feasibility and results of intrasaccular double microcatheter endovascular coil embolization of overwide and undertall small intracranial aneurysms. METHODS Small (<7 mm), overwide (dome-to-neck ratio [DNR] ≤1.2), and undertall (ASPECT ratio ≤1.2) aneurysms which were treated with double microcatheter technique were selected. For the double microcatheter technique, two microcatheters were selected simultaneously into the aneurysm sac and coil insertion was performed alternatingly. The initial results, ASPECT, DNR ratios, complications, and follow-up results were assessed. RESULTS Twenty small (mean, 3.8 mm), overwide (mean DNR, 1.1), and undertall (mean ASPECT, 1.0) aneurysms were treated with the double microcatheter technique. Overall, complete or near complete occlusion was achieved in 19/20 cases. This was achieved with only the double microcatheter technique in 16/20 cases (ASPECT mean, 1.0; DNR mean, 1.1). Adjuvant balloon remodeling was performed in 4/20 cases (ASPECT mean, 0.8; DNR mean, 1.1). The ASPECT ratio was significantly lower in the adjuvant balloon remodeling cases (p = 0.027). Coiling failed in one patient with both DNR and ASPECT ratio <1.0. Overall, one patient developed a focal visual field defect after the procedure. No other patients developed neurologically significant complications. CONCLUSIONS Double microcatheter technique may be a safe and effective method for the treatment of overwide and undertall small intracranial aneurysms.
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Abstract
BACKGROUND Determining factors predictive of the natural risk of rupture of cerebral aneurysms is difficult. We studied morphological factors associated with rupture in a study model of patients with mirror location intracranial aneurysms, one aneurysm that had ruptured and one that had not, each patient served as their own control attempting to eliminate confounding variables. METHODS We collected five one-dimensional measurements and four two-dimensional indices from three-dimensional rotational digital subtraction angiography images of patients in the proposed study model and explored their correlation with aneurysm rupture. Parameters were analyzed with a paired Student's t test for significance and significant parameters were further examined by multivariate conditional logistic regression analysis. RESULTS Fifty-two patients with 52 pairs of intracranial aneurysms in a mirror location were studied. The maximum perpendicular height, neck diameter, maximum width, maximum height, aspect ratio, size ratio, and bottleneck factor were significantly associated with ruptured aneurysms on bivariate analysis. A logistic regression analysis showed that only size ratio, which was defined as the ratio of the maximal height to parent artery average diameter, is independently correlated with ruptured intracranial aneurysms. CONCLUSIONS In a case-control study of patients with mirror location intracranial aneurysms, size ratio was identified as the unique morphological factor associate with the rupture of cerebral aneurysms.
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Morita A. Current Perspectives on the Unruptured Cerebral Aneurysms: Origin, Natural Course, and Management. J NIPPON MED SCH 2014; 81:194-202. [DOI: 10.1272/jnms.81.194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Akio Morita
- Department of Neurosurgery, Nippon Medical School
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38
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Mehan WA, Romero JM, Hirsch JA, Sabbag DJ, Gonzalez RG, Heit JJ, Schaefer PW. Unruptured intracranial aneurysms conservatively followed with serial CT angiography: could morphology and growth predict rupture? J Neurointerv Surg 2013; 6:761-6. [DOI: 10.1136/neurintsurg-2013-010944] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Perioperative variables contributing to the rupture of intracranial aneurysm: an update. ScientificWorldJournal 2013; 2013:396404. [PMID: 24324371 PMCID: PMC3845728 DOI: 10.1155/2013/396404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 09/11/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Perioperative aneurysm rupture (PAR) is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012) using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history) as well as the pathophysiological factors (size, type, location, comorbidities, and procedure). Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better clinical management as well as patient care in this group and will give insight into the development and prevention of such a catastrophic complication in these patients.
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Etminan N, Buchholz BA, Dreier R, Bruckner P, Torner JC, Steiger HJ, Hänggi D, Macdonald RL. Cerebral aneurysms: formation, progression, and developmental chronology. Transl Stroke Res 2013; 5:167-73. [PMID: 24323717 DOI: 10.1007/s12975-013-0294-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/06/2013] [Accepted: 10/08/2013] [Indexed: 02/08/2023]
Abstract
The prevalence of unruptured intracranial aneurysms (UIAs) in the general population is up to 3%. Existing epidemiological data suggests that only a small fraction of UIAs progress towards rupture over the lifetime of an individual, but the surrogates for subsequent rupture and the natural history of UIAs are discussed very controversially at present. In case of rupture of an UIA, the case fatality is up to 50%, which therefore continues to stimulate interest in the pathogenesis of cerebral aneurysm formation and progression. Actual data on the chronological development of cerebral aneurysm has been especially difficult to obtain and, until recently, the existing knowledge in this respect is mainly derived from animal or mathematical models or short-term observational studies. Here, we review the current data on cerebral aneurysm formation and progression as well as a novel approach to investigate the developmental chronology of cerebral aneurysms.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Dusseldorf, Germany,
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Gemmete JJ, Elias AE, Chaudhary N, Pandey AS. Endovascular methods for the treatment of intracranial cerebral aneurysms. Neuroimaging Clin N Am 2013; 23:563-91. [PMID: 24156851 DOI: 10.1016/j.nic.2013.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article briefly discusses the clinical features, natural history, and epidemiology of intracranial cerebral aneurysms, along with current diagnostic imaging techniques for their detection. The main focus is on the basic techniques used in endovascular coiling of ruptured and nonruptured saccular intracranial cerebral aneurysms. After a discussion of each technique, a short review of the results of each form of treatment is given, concentrating on reported large case series. Specific complications related to the endovascular treatment of saccular intracranial aneurysms are then discussed.
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Affiliation(s)
- Joseph J Gemmete
- Division of Interventional Neuroradiology and Cranial Base Surgery, Departments of Radiology, Neurosurgery, and Otolaryngology, University of Michigan Health System, UH B1D 328, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5030, USA.
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Liang Y, Wang J, Li B. Coexistence of internal carotid artery stenosis with intracranial aneurysm. Int J Stroke 2013; 9:306-7. [PMID: 23981434 DOI: 10.1111/ijs.12096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 01/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies have hypothesized that alterations in haemodynamics and rheological properties in the main vessels like the main stem of the carotid artery or the internal carotid arteries are responsible for the formation of cerebral aneurysms. AIMS The objectives of the current analyses were to collate data that have examined the occurrence of cerebral aneurysm with coexisting internal carotid artery stenosis. METHODS Data sources were collated from detailed PubMed search obtained from 1990 till current. Published literature that deals with the epidemiologic properties as well as prevalence was scanned for data extraction. Publications that reported coexistence of internal carotid artery stenosis with intracranial aneurysm, detected by any modality of imaging, was included in the current study. Spearman's correlation analyses were used to obtain significant information of coexistence of an intracranial aneurysm with an extracranial internal carotid artery stenosis. RESULTS The frequency of concurrent extracranial internal carotid artery stenosis and an unruptured cerebral artery aneurysm is not known exactly, but has been estimated to be approximately 4%. The major limitations of the current analyses actually can be retrospectively traced to the lack of detailed analyses in this important area of investigation. CONCLUSIONS Although low in absolute occurrence, there is a significant correlation of the existence of an intracranial aneurysm with carotid artery stenosis. Thus, if peripheral stenosis is detected by any imaging modality including carotid Ultrasonography scan, we recommend digital subtraction intracranial angiography to detect any potential aneurysm and define its radiologic morphology.
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Affiliation(s)
- Yongping Liang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
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Müller TB, Sandvei MS, Kvistad KA, Rydland J, Håberg A, Vik A, Gårseth M, Stovner LJ. Unruptured Intracranial Aneurysms in the Norwegian Nord-Trøndelag Health Study (HUNT). Neurosurgery 2013; 73:256-61; discussion 260; quiz 261. [DOI: 10.1227/01.neu.0000430295.23799.16] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Vlak MH, Rinkel GJ, Greebe P, Algra A. Risk of Rupture of an Intracranial Aneurysm Based on Patient Characteristics. Stroke 2013; 44:1256-9. [DOI: 10.1161/strokeaha.111.000679] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Knowledge about risk factors contributes to understanding the pathophysiological mechanisms that cause intracranial aneurysm rupture and helps to develop possible treatment strategies. We aimed to study lifestyle and personal characteristics as risk factors for the rupture of intracranial aneurysms.
Methods—
We performed a case–control study with 250 patients with an aneurysmal subarachnoid hemorrhage and 206 patients with an unruptured intracranial aneurysm. All patients with an aneurysmal subarachnoid hemorrhage and patients with a unruptured intracranial aneurysm were asked to fill in a structured questionnaire about their lifestyle and medical history. For patients with an unruptured intracranial aneurysm, we also collected data on the indication for imaging. With logistic regression analysis, we identified independent risk factors for aneurysmal rupture.
Results—
Reasons for imaging in patients with an unruptured intracranial aneurysm were atherosclerotic disease (23%), positive family history (18%), headache (8%), preventive screening (3%), and other (46%). Factors that increased risk for aneurysmal rupture were smoking (odds ratio, 1.9; 95% confidence interval, 1.2–3.0) and migraine (2.4; 1.1–5.1); hypercholesterolemia decreased this risk (0.4; 0.2–1.0), whereas a history of hypertension did not independently influence the risk.
Conclusions—
Smoking, migraine and, inversely, hypercholesterolemia are independent risk factors for aneurysmal rupture. Data from the questionnaire are insufficient to conclude whether hypercholesterolemia or its treatment with statins exerts a risk-reducing effect. The pathophysiological mechanisms through which smoking and migraine increase the risk of aneurysmal rupture should be investigated in further studies. Although a history of hypertension does not increase risk of rupture, a sudden rise in blood pressure might still trigger aneurysmal rupture.
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Affiliation(s)
- Monique H.M. Vlak
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (M.H.M.V., G.J.E.R., P.G., A.A.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center, Utrecht, The Netherlands; and Department of Neurology, Slotervaart Hospital, Amsterdam, The Netherlands (M.H.M.V.)
| | - Gabriel J.E. Rinkel
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (M.H.M.V., G.J.E.R., P.G., A.A.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center, Utrecht, The Netherlands; and Department of Neurology, Slotervaart Hospital, Amsterdam, The Netherlands (M.H.M.V.)
| | - Paut Greebe
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (M.H.M.V., G.J.E.R., P.G., A.A.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center, Utrecht, The Netherlands; and Department of Neurology, Slotervaart Hospital, Amsterdam, The Netherlands (M.H.M.V.)
| | - Ale Algra
- From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (M.H.M.V., G.J.E.R., P.G., A.A.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center, Utrecht, The Netherlands; and Department of Neurology, Slotervaart Hospital, Amsterdam, The Netherlands (M.H.M.V.)
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Hokari M, Kuroda S, Nakayama N, Houkin K, Ishikawa T, Kamiyama H. Long-term prognosis in patients with clipped unruptured cerebral aneurysms―increased cerebrovascular events in patients with surgically treated unruptured aneurysms. Neurosurg Rev 2013; 36:567-71; discussion 571-2. [DOI: 10.1007/s10143-013-0465-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/07/2012] [Accepted: 01/06/2013] [Indexed: 11/27/2022]
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Caranci F, Briganti F, Cirillo L, Leonardi M, Muto M. Epidemiology and genetics of intracranial aneurysms. Eur J Radiol 2013; 82:1598-605. [PMID: 23399038 DOI: 10.1016/j.ejrad.2012.12.026] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/16/2012] [Accepted: 12/17/2012] [Indexed: 11/18/2022]
Abstract
Intracranial aneurysms are acquired lesions (5-10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3-p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3-p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2 gene). Moreover, 3 of the polymorphisms analyzed in 2 genes (endothelial nitric oxide synthase T786C, interleukin-6 G572C, and interleukin-6 G174C) were found to be significantly associated with ruptured/unruptured aneurysms: the endothelial nitric oxide synthase gene single-nucleotide polymorphisms increased the risk, while IL-6 G174C seemed protective. More recently, two genomic loci (endothelin receptor A and cyclin-dependent kinase inhibitor 2BAS) have been found to be significantly associated with intracranial aneurysms in the Japanese population; endothelin-1 is a potent vasoconstrictor produced by the endothelial cells. Until now, there are no diagnostic tests for specific genetic risk factors to identify patients who are at a high risk of developing intracranial aneurysms. Knowledge of the genetic determinants may be useful in order to allow clues on stopping aneurysm formation and obtain diagnostic tools for identifying individuals at increased risk. Further multicenter studies have to be carried out.
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Affiliation(s)
- F Caranci
- Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples, Italy.
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Incidence of growth and rupture of unruptured intracranial aneurysms followed by serial MRA. Acta Neurochir (Wien) 2013. [PMID: 23196925 DOI: 10.1007/s00701-012-1566-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The natural history, including growth and rupture, of unruptured intracranial aneurysms (UIAs) remains unknown. Here, we present the results of serial magnetic resonance angiography (MRA) follow-up study in 111 patients with 136 UIAs. METHOD A total of 111 patients with 136 UIAs were followed annually over the past 12 years, using 1.5-Tesla MRA. Follow-up was ended when UIAs were treated surgically, or the patients died of subarachnoid hemorrhage or other causes. Various factors influencing aneurysm rupture or growth were examined statistically. RESULTS Aneurysm rupture and growth occurred in six and 13 of the 111 patients, respectively. Annual rupture rate was 1.8 % per year and annual growth rate was 3.9 % per year. Aneurysm size was the sole factor influencing rupture(H.R. 1.214, 95 % CI, 1.078-1.368) and multiplicity was the sole factor influencing aneurysm growth (H.R. 5.174, 95 % CI 1.81-14.80). CONCLUSIONS Serial MRA study showed that the incidence of UIA growth was twice as high as that of UIA rupture. As four patients showed aneurysm rupture or growth within 1 year, further investigations are necessary to determine the optimum interval of radiological investigation and to identify which UIAs grow or rupture within a short time.
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Maruyama K, Kurita H, Yamaguchi R, Noguchi A, Shiokawa Y. One-Stage Clipping of Bilateral Middle Cerebral Artery Aneurysms Via the Bilateral Pterional Keyhole Approach. Neurol Med Chir (Tokyo) 2013; 53:148-52. [DOI: 10.2176/nmc.53.148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Keisuke Maruyama
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
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Gu DQ, Duan CZ, Li XF, He XY, Lai LF, Su SX. Effect of endovascular treatment on headache in elderly patients with unruptured intracranial aneurysms. AJNR Am J Neuroradiol 2012; 34:1227-31. [PMID: 23221953 DOI: 10.3174/ajnr.a3353] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of unruptured intracranial aneurysms is increasing in the elderly population as life expectancy increases, and patients often present with headache. The goal of this study was to determine the effect of endovascular treatment on headache and identify factors associated with headache outcome in elderly patients with unruptured intracranial aneurysms. MATERIALS AND METHODS A retrospective study was conducted for elderly patients (≥ 65 years old) being treated for unruptured intracranial aneurysms. Headache assessment was performed by a quantitative 11-point headache scale in all patients before and after endovascular treatment. Factors associated with headache outcome were investigated by univariate analyses. RESULTS A total of 72 patients (mean age, 70.0 years; age range, 65-80 years; 41 women) fulfilled the inclusion criteria. There were 52 patients (72.2%) who presented with preoperative headache (headache score ≥ 1). Among them, 40 (76.9%) reported that headache score had an improvement according to their self-reported quantitative headache score after endovascular treatment. The average headache score was 5.63 preoperatively vs 2.50 postoperatively (P = .000). Twenty patients (27.8%) had no headache before treatment (headache score = 0), of whom 2 (10.0%) reported new onset of headache postoperatively. Only a preoperative headache score was associated with treatment outcome of headache, and a higher headache score predicted a lack of headache relief after endovascular treatment (P = .003). CONCLUSIONS Endovascular coiling of unruptured intracranial aneurysms resulted in relief of headache in most of the elderly patients. Preoperative headache score was the only statistically significant predictor of headache outcome.
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Affiliation(s)
- D-Q Gu
- Department of Neurosurgery, Neurosurgery Institute, Key Laboratory on Brain Function Repair and Regeneration of Guangdong, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366:2474-82. [PMID: 22738097 DOI: 10.1056/nejmoa1113260] [Citation(s) in RCA: 962] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The natural history of unruptured cerebral aneurysms has not been clearly defined. METHODS From January 2001 through April 2004, we enrolled patients with newly identified, unruptured cerebral aneurysms in Japan. Information on the rupture of aneurysms, deaths, and the results of periodic follow-up examinations were recorded. We included 5720 patients 20 years of age or older (mean age, 62.5 years; 68% women) who had saccular aneurysms that were 3 mm or more in the largest dimension and who initially presented with no more than a slight disability. RESULTS Of the 6697 aneurysms studied, 91% were discovered incidentally. Most aneurysms were in the middle cerebral arteries (36%) and the internal carotid arteries (34%). The mean (±SD) size of the aneurysms was 5.7±3.6 mm. During a follow-up period that included 11,660 aneurysm-years, ruptures were documented in 111 patients, with an annual rate of rupture of 0.95% (95% confidence interval [CI], 0.79 to 1.15). The risk of rupture increased with increasing size of the aneurysm. With aneurysms that were 3 to 4 mm in size as the reference, the hazard ratios for size categories were as follows: 5 to 6 mm, 1.13 (95% CI, 0.58 to 2.22); 7 to 9 mm, 3.35 (95% CI, 1.87 to 6.00); 10 to 24 mm, 9.09 (95% CI, 5.25 to 15.74); and 25 mm or larger, 76.26 (95% CI, 32.76 to 177.54). As compared with aneurysms in the middle cerebral arteries, those in the posterior and anterior communicating arteries were more likely to rupture (hazard ratio, 1.90 [95% CI, 1.12 to 3.21] and 2.02 [95% CI, 1.13 to 3.58], respectively). Aneurysms with a daughter sac (an irregular protrusion of the wall of the aneurysm) were also more likely to rupture (hazard ratio, 1.63; 95% CI, 1.08 to 2.48). CONCLUSIONS This study showed that the natural course of unruptured cerebral aneurysms varies according to the size, location, and shape of the aneurysm. (Funded by the Ministry of Health, Labor, and Welfare in Japan and others; UCAS Japan UMIN-CTR number, C000000418.).
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