Morphological characteristics associated with rupture risk of multiple intracranial aneurysms

Objective To identify the morphological parameters that are related to intracranial aneurysms (IAs) rupture using a case-control model. Methods A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study. Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter (PVD), aspect ratio (AR) and size ratio (SR) were evaluated using CT angiography. Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained. Results IAs located in the internal carotid artery (ICA) was associated with a negative risk of rupture, whereas AR, SR1 (height/PVD) and SR2 (depth/PVD) were associated with increased risk of rupture. When SR was calculated differently, the odds ratio values of these factors were also different. The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively. SR3 (maximum size/PVD) was not associated with IAs rupture. Conclusions IAs located in the ICA are associated with a negative risk of rupture, while high AR (>1.01), SR1 (>1.48) or SR2 (>1.40) are risk factors for multiple IAs rupture.

Morphological characteristics associated with rupture risk of multiple intracranial aneurysms

OBJECTIVE@#To identify the morphological parameters that are related to intracranial aneurysms (IAs) rupture using a case-control model.@*METHODS@#A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study. Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter (PVD), aspect ratio (AR) and size ratio (SR) were evaluated using CT angiography. Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.@*RESULTS@#IAs located in the internal carotid artery (ICA) was associated with a negative risk of rupture, whereas AR, SR1 (height/PVD) and SR2 (depth/PVD) were associated with increased risk of rupture. When SR was calculated differently, the odds ratio values of these factors were also different. The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively. SR3 (maximum size/PVD) was not associated with IAs rupture.@*CONCLUSIONS@#IAs located in the ICA are associated with a negative risk of rupture, while high AR (>1.01), SR1 (>1.48) or SR2 (>1.40) are risk factors for multiple IAs rupture.

The accuracy of Computed Tomography Angiography (CTA) in diagnosis of multiple intracranial aneurysms / 中国神经精神疾病杂志

Objective The purpose of this study is to explore the clinical value of CT angiography( CTA) in the diagnosis of multiple intracranial aneurysms.Methods The data of CTA and DSA from 74 patients with multiple intracra-nial aneurysms from July 2011 to March 2015 were reviewed retrospectively.Results One hundred seventy-seven aneu-rysms were detected by DSA, and 175 aneurysms were detected by CTA.Among the aneurysms identified by CTA, 4 aneu-rysms were false positive and the correct detection rate of CTA was 96.6%.One hundred sixty-five aneurysms identified by CTA were confirmed by DSA and the correct diagnostic rate of CTA was 96.5%.CTA failed to detect 6 aneurysms and mis-diagnosed 10 aneurysms.Conclusions The correct detection rate and diagnostic rate of CT angiography ( CTA) in multiple intracranial aneurysms is relatively high.But previous surgery, spasm of the vessels, the size and number of aneurysms, radiologists'experience can influence the accuracy of ( CTA) in the diagnosis of multiple intracranial aneurysms, indicating that we should combine CTA with DSA to avoid the misdiagnosis and missed diagnosis.

Three-dimensional CT angiography with volume rendering for the dignosis of multiple intracranial aneurysms / 中国脑血管病杂志

Objective:To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with multiplanar reformation. Results: In the past one year,there were 10 patients diagnosed as having multiple intracranial aneurysms by 3D-CTA and altogether 24 aneurysms were visualized,including 10 small aneurysms(≤5mm.Three dimensional CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site,shape,size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick,reliable,and relatively noninvasive method for diagnosing multiple intracranial aneurysms.It delineates detailed aneurysmal morphology,and provides useful information for planning microsurgical approaches.

Clinical Analysis of Determining the Primary Rupture Site in Multiple Intracranial Aneurysms: Preliminary Report

OBJECTIVE: Misjudgement of rupture site may result in disastrous postoperative rebleeding from the unclipped but truly ruptured aneurysm. We assess the concordance rate between radiologic findings and operative ones, and then we document the problems in false localization of rupture site in multiple intracranial aneurysms. METHODS: From January 2001 to December 2002, We retrospectively analyzed 14 patients with a total of 32 multiple aneurysms to assess the primary rupture site. The rupture site was determined on the basis of computed tomographic and angiographic findings by neurosurgeons and one neuroradiologist. The operative findings such as healed thrombotic cap, localized clot, and easy collapse before and after clipping of ruptured aneurysms were compared with the predicted radiologic findings. On the other hand, we analyzed the causes in the cases of false localization. RESULTS: The location of ruptured aneurysm was verified at the time of surgery in 10 patients. The concordance rate of localized clot(100%) was higher than laterality of subarachnoid hemorrhage(66.7%) on CT scan, and those of focal vasospasm and nipple formation(100%) were also higher than size(72.7%) or irregularity(83.3%) of aneurysms on angiographic findings. Two of four misjudged patients were expired due to rebleeding from unclipped aneurysms. CONCLUSION: Although most reliable radiologic findings are useful in determination of rupture site, we should also consider less reliable radiologic findings and careful surgical inspection of the target aneurysm. And then early second operation should be performed as soon as possible in cases of misjudgment on initial diagnosis.

Surgical Treatment of Bilateral Intracranial Aneurysms

The incidence of the bilateral intracranial aneurysms in multiple aneurysms ranges from 20 to 40% in the published series12). The problems of surgery for multiple aneurysms are far greater than those for single aneurysm. Occasionally,the ruptured site of bilateral symmetrical(mirror image) aneurysms are more difficult to identify. To verify the standard treament, we investigated their clinical data and surgical modalities of 43 patients with bilateral aneurysms. We classified the bilateral aneurysms as symmetrical and asymmetrical aneurysms. Most common bilateral symmetrical aneurysms were located at origin of posterior communicating artery. Surgical modalities were separate craniotomy with ipsilateral approach(29 cases) and a single craniotomy with ipsilateral and contralateral approach (6 cases). The rest of patients were treated only in the presence of symatomatic lesions. Seven patients died of various causes; two were rebleeding, three were surgical mortalities, and two had medical complications. The surgical results were good to fair in 26 cases of separate operation and had good to fair outcome of 5 cases with 1 case of poor outcome in the single craniotomy with combined ipsilateral and contralateral approach. Surgical goal in patient with bilateral aneruysms is clipping of all aneurysms. In selected cases, the contralateral approach with a single craniotomy can be employed. Proper surgical techniques and guideline for microsurgical exposure of bilateral aneurysms are mandatory.

Overview of Surgical Result of Multiple Intracranial Aneurysmal Patients

From January 1990 to January 1996, we analyzed outcome according to the distribution of aneurysms, the type of surgical treatment, the timing of operation, and the patient's pre-operative status in a total of 54 cases of multiple intracranial aneurysms. The frequency of multiple intracranial aneurysms was 13.4% and the sex ratio was 1:2 with female being predominant. The frequency of aneurismal location was MCA(35.0%), P-comm. Artery(25.0%) and A-comm. Artery(15.0%) in that order. The number of ruptured aneurysms was in the order to MCA aneurysms. A-comm aneurysms, and P-comm aneurysms. The size of ruptured aneurysms was 6-10mm in 34 cases(64.2%). The unilateral distribution of aneurysms was 31 cases(57.4%) and the bilateral was 28 cases(42.6%). Depending on how many times the patient had the operation, these were 29(57.4%) cases of complete single operation, 17 cases(31.5%) of complete two-stage operation, and 8 cases(14.8%) of partial operation. Surgical outcome was good(GOS< or =4) in 42 cases(77.8%), and six patients(11.1%) expired. Based on the results of the above study we have concluded that initial Hunt-Hess grade has a close relationship with the outcome, but the operation type, the timing of operation, the number and distribution of aneurysms do not significantly effect the outcome.

Clinical Analysis of Multiple Intracranial Aneurysms

A retrospective review of 54 patients with multiple intracranial aneurysms seen over a 5 year period was performed. Among the 252 patients with aneurysms, the incidence of multiple aneurysms was 21.4%. Multiple aneurysms were slightly more common in women with a female to male ratio of 1.35:1. But there was no different ratio for patients with three or more aneurysms. Common clinical features were headache(96%), meningeal sign(83%), and change of consciousness level(52%). The most common Fisher's grade was III(63%), according to brain CT finding. Common locations of multiple aneurysms were the PcomA(35.7%), MCA(24.8%), AcomA(17.8%), and ICA bifurcation(7.7%). However, the aneurismal locations with the highest incidence of rupture were the MCA(53.1%). AcomA(52.1%), basilar bifurcation(50%). The PcomA(34.7%) was the least likely site for rupture. On the distribution of multiple aneurysms according to location, unilateral and midline located multiple aneurysms were 49%. Size was more important than irregularity of the shape in identifying the site of rupture. Most ruptured aneurysms were 5mm or larger in size. Postoperative mortality was 4.4% and the most common cause of postoperative mortality was cerebral vasoapasm.

Two Bilateral Symmetrical Cases of 4 Multiple Intracranial Aneurysms

Two cases of 4 Multiple Intracranial Aneurysms are presented. The author believes that patients who have had a subarachnoid hemorrhage should have four-vessel arteriography to identify all aneurysms, and that all surgically accessible aneuryms should be treated. Surgery of multiple aneurysms should be performed at the same craniotomy if they are within reach. Hower, if the asymptomatic or incidental aneurysm is in the opposite side or cannot be reached in the initial surgical procedure, it should be treated at a lager craniotomy.

Clinical Analysis of Multiple Intracranial Aneurysms

Mulitiple intracranial aneurysms occur in range of 15% to 30% of all patients with intracranial aneurysms. The treatment of such patients offers a particular challenge for the neurosurgeon. Early reports dealing with multiple aneurysms recommended treatment of only the ruptured aneurysm, but recently, authors have advised treatment of all significant aneurysms. We performed a retrospective review for 63 patients with multiple intracranial aneurysms, admitted to Department of Neurosurgery, Kyung-Hee University Hospital between Jun. 1982 and Dec. 1989. The present study includes the incidence of multiple aneurysms, its age and sex distribution, aneurysm locations, probability of rupture, relationship of aneurysmal size and rupture, and operative results. The results were as follows ; 1) Multiple intracranial aneurysms occurred in about 12.2% of all patient with aneurysms. 2) The female to male ratio was about 2.3:1 for patients with two aneurysms and 5:1 for patients with three or more aneurysms. 3) Common location for multiple aneurysms were the PCoA, ICA, ACoA, and MCA. 4) On the distribution of multiple aneurysms according to location, unilateral and midline located mutliple aneurysms were 61.9%. 5) Probability of aneurysmal rupture according to site was(in decreasing order) ACoA, PCoA, AChoA, MCA, and ICA bifurcation. 6) Irregularity of shape was more inportant than size in identifying the site of rupture. 7) Most unruptured aneurysms were 5mm or smaller in size ; however, most ruptured aneurysms were 6mm or larger. 8) About 70% of surgical management showed good and fair result.

Multiple Intracranial Aneurysms Associated with Polycystic Disease: A Case Report

We have experienced a rare case of multiple intracranial aneurysms associated with polycystic kidney and polycystic liver, which were incidental findings after minor leakage. A 57-year-old female was admitted with the chief complaint of severe headache under the impression of subarachnoid hemorrhage due to rupture of the intracranial aneurysm(which were appeared as the right middle cerebral artery and A-com aneurysm). The brain CT scan showed subarachnoid hemorrhage in the right sylvian fissure and the right temporal lobe. On physical examination, 2FB hard irregular palpable mass was noted on the right costal margin. On neurological examination, her neck was mildly stiff and other signs were within normal limit. We checked abdominal sonography, abdominal CT scan and carotid angiography preoperatively, and reviewed the literature about polycystic disease associated with intracranial aneurysm and discussed about it.