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Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SCC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2368-400. [PMID: 26089327 DOI: 10.1161/str.0000000000000070] [Citation(s) in RCA: 599] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. METHODS Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.
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Multiple Cerebral Myxomatous Aneurysms: What Is the Optimal Treatment? J Stroke Cerebrovasc Dis 2015; 24:232-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/17/2014] [Accepted: 08/22/2014] [Indexed: 11/30/2022] Open
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Liu H, Zhang T, Jiao S, Li B, Guan J, Wang YXJ. Epidemiological investigation of 264 sporadic cases of ruptured cerebral aneurysm at a single institution in southwest China. Neuropsychiatr Dis Treat 2015; 11:1609-14. [PMID: 26170673 PMCID: PMC4494622 DOI: 10.2147/ndt.s86607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the epidemiology of sporadic ruptured cerebral aneurysm in the Chinese population. METHODS We retrospectively analyzed the medical records of 264 consecutive Chinese patients admitted to the Affiliated Hospital of Zunyi Medical University of Guizhou Province in Southwest China between December 2012 and March 2015 for spontaneous subarachnoid hemorrhage due to a ruptured cerebral artery aneurysm. RESULTS The study population comprised 171 females and 93 males with a median age of 50 (range 5-76) years. The female to male ratio was 1.84:1. For both males and females, aneurysm rupture was most common in the 40-49-year age group (34.5%). Most of the ruptured aneurysms were in the size range of 2-5 mm (47.2%), followed by 5-10 mm (43.8%). Ruptured aneurysms occurred most often in the posterior communicating artery (36.6%) or the anterior communicating artery (25.7%). There were more cases of anterior communicating artery aneurysm on the left side (53 [Left side]/16 [Right side]=3.31, P>0.001) and slightly more cases of posterior communicating artery aneurysm on the right side (54 [Right side]/44[Left side]=1.23, P<0.05). CONCLUSION This study provides valuable information on the epidemiology of ruptured cerebral aneurysm in the Chinese population.
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Affiliation(s)
- Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Tijiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Song Jiao
- Cerebrovascular Diseases Clinic, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Bangguo Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Jing Guan
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, People's Republic of China
| | - Yi-Xiang J Wang
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, People's Republic of China
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Influence of morphology and hemodynamic factors on rupture of multiple intracranial aneurysms: matched-pairs of ruptured-unruptured aneurysms located unilaterally on the anterior circulation. BMC Neurol 2014; 14:253. [PMID: 25551809 PMCID: PMC4301794 DOI: 10.1186/s12883-014-0253-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The authors evaluated the impact of morphological and hemodynamic factors on the rupture of matched-pairs of ruptured-unruptured intracranial aneurysms on one patient's ipsilateral anterior circulation with 3D reconstruction model and computational fluid dynamic method simulation. METHODS 20 patients with intracranial aneurysms pairs on the same-side of anterior circulation but with different rupture status were retrospectively collected. Each pair was divided into ruptured-unruptured group. Patient-specific models based on their 3D-DSA images were constructed and analyzed. The relative locations, morphologic and hemodynamic factors of these two groups were compared. RESULTS There was no significant difference in the relative bleeding location. The morphological factors analysis found that the ruptured aneurysms more often had irregular shape and had significantly higher maximum height and aspect ratio. The hemodynamic factors analysis found lower minimum wall shear stress (WSSmin) and more low-wall shear stress-area (LSA) in the ruptured aneurysms than that of the unruptured ones. The ruptured aneurysms more often had WSSmin on the dome. CONCLUSIONS Intracranial aneurysms pairs with different rupture status on unilateral side of anterior circulation may be a good disease model to investigate possible characteristics linked to rupture independent of patient characteristics. Irregular shape, larger size, higher aspect ratio, lower WSSmin and more LSA may indicate a higher risk for their rupture.
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Clinical characteristics and preferential location of intracranial mirror aneurysms: a comparison with non-mirror multiple and single aneurysms. Neuroradiology 2014; 57:35-40. [PMID: 25277245 DOI: 10.1007/s00234-014-1437-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of our study was to compare the clinical characteristics and preferential localization of aneurysms in three patient groups: single aneurysm, non-mirror multiple aneurysms, and mirror aneurysms. METHODS We retrospectively reviewed the clinical and radiological data of 2223 consecutive patients harboring 3068 aneurysms registered at the Toronto Western Hospital between May 1994 and November 2010. The patients were divided into single, non-mirror multiple, or mirror aneurysm groups. Expected incidences of mirror aneurysms at each location were calculated on the basis of the single aneurysm incidences at each location. RESULTS Patients with mirror aneurysms (n = 197) did not differ from patients with non-mirror multiple aneurysms (n = 392) in having female predominance (81.7 vs. 76.3 %) or a family history of intracranial aneurysm (20.5 vs. 17.6 %). When compared with expected incidences at each location, mirror aneurysms were more frequently found at the cavernous internal carotid artery (30 vs. 11.5 %) (p < 0.0001). Mirror aneurysms involving the posterior circulation were less frequent (6.7 %) than aneurysms in the single (19.6 %) or non-mirror multiple aneurysm groups (18.9 %) (p < 0.05). CONCLUSION Patients with mirror aneurysms had similar clinical characteristics to non-mirror multiple aneurysm patients. Mirror aneurysms showed a predilection for the cavernous carotid artery, whereas they were comparatively rare in the posterior circulation.
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Hamdan A, Barnes J, Mitchell P. Subarachnoid hemorrhage and the female sex: analysis of risk factors, aneurysm characteristics, and outcomes. J Neurosurg 2014; 121:1367-73. [PMID: 25216063 DOI: 10.3171/2014.7.jns132318] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Sex may play a role in the outcome of patients with aSAH. METHODS The authors retrospectively identified 617 patients with aSAH (April 2005 to February 2010) and analyzed sex differences in risk factors (age, hypertension, smoking, alcohol consumption, and family history), admission-related factors (World Federation of Neurosurgical Societies grade and admission delay), aneurysm characteristics (site, side, location, and multiplicity), and outcomes (treatment modalities [coiling/clipping/both/conservative], complications [vasospasm and hydrocephalus], length of stay, and modified Rankin Scale score at 3 months). RESULTS The female patients with aSAH were older than the male patients (mean age 56.6 vs 51.9 years, respectively, p < 0.001), and more women than men were ≥ 55 years old (56.2% vs 40.4%, respectively, p < 0.001). Women exhibited higher rates of bilateral (6.8% vs 2.6%, respectively, p < 0.05), multiple (11.5% vs 5.2%, respectively, p < 0.05), and internal carotid artery (ICA) (36.9% vs 17.5%, respectively, p < 0.001) aneurysms and a lower rate of anterior cerebral artery aneurysms (26.3% vs 44.8%, respectively, p < 0.001) than the men, but no side differences were noted. There were no sex differences in risk factors, admission-related factors, or outcome measures. For both sexes, outcomes varied according to aneurysm location, with odds ratios for a poor outcome of 1.62 (95% CI 0.91-2.86, p = 0.1) for middle cerebral artery, 2.41 (95% CI 1.29-4.51, p = 0.01) for ICA, and 2.41 (95% CI 1.29-4.51, p = 0.006) for posterior circulation aneurysms compared with those for anterior cerebral artery aneurysms. The odds ratio for poor outcome (modified Rankin Scale score of 4-6) in women compared with men after adjusting for significant prognostic factors was 0.71 (95% CI 0.45-1.11, p > 0.05). CONCLUSIONS The overall outcomes after aSAH between women and men are similar.
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Defillo A. Are Multiple Intracranial Aneurysms, More Than 5 At One Time, Almost Exclusively A Female Disease? A Clinical Series and Literature Review. ACTA ACUST UNITED AC 2014. [DOI: 10.15406/jnsk.2014.01.00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lindgren AE, Kurki MI, Riihinen A, Koivisto T, Ronkainen A, Rinne J, Hernesniemi J, Eriksson JG, Jääskeläinen JE, von und zu Fraunberg M. Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland. Ann Med 2014; 46:169-76. [PMID: 24579936 DOI: 10.3109/07853890.2014.883168] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Hypertension associates with subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) when compared to matched controls or general population. Few series compare hypertension in unruptured sIA versus sIA-SAH, so its impact on the sIA disease remains uncertain. METHODS Kuopio sIA Database ( www.uef.fi/ns ) contains all cases of unruptured and ruptured sIAs admitted to Kuopio University Hospital from its Eastern Finnish catchment population. We compared the age-adjusted incidence of drug-treated hypertension in 467 unruptured and 1053 ruptured sIA patients admitted to Kuopio University Hospital from 1995 to 2007, using the national registry of prescribed medicines. RESULTS Antihypertensive medication was more frequent in the unruptured (73% versus 62%) with higher age-adjusted incidence. At sIA diagnosis, the sIA-SAH group had more often untreated hypertension (29% versus 23%). The size of unruptured sIAs increased with age at sIA diagnosis, independently of hypertension. Multiple sIAs, familial sIA, and sIA-SAH were not associated with hypertension in multivariate analysis. Results indicate that drug-treated hypertension associates with the formation of sIAs rather than their growth or rupture. CONCLUSION Hypertension is highly prevalent in the carriers of unruptured sIAs when compared to those with ruptured sIA. Hypertension may associate with the sIA formation, and may predispose to the rupture of sIA if untreated.
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Affiliation(s)
- Antti E Lindgren
- Neurosurgery of NeuroCenter, Kuopio University Hospital , Kuopio , Finland
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Zhao L, Zhang L, Zhang X, Li Z, Tian L, Wang YXJ. An analysis of 1256 cases of sporadic ruptured cerebral aneurysm in a single Chinese institution. PLoS One 2014; 9:e85668. [PMID: 24454914 PMCID: PMC3893225 DOI: 10.1371/journal.pone.0085668] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/30/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To review the epidemiology of sporadic ruptured cerebral aneurysm. METHODS This is a retrospective study of consecutive 1256 Chinese patients between January 2006 and January 2013, who were admitted to the Second Hospital of Hebei Medical University, China, for spontaneous subarachnoid hemorrhage due to a rupture of cerebral artery aneurysm. In 288 males and 478 females, the size of aneurysms was measured by a neuroradiologist on DSA. In 123 males and 184 females, the size of the ruptured aneurysms was not measured. The remaining patients, with 61 males and 122 females, had multiple aneurysms, and the medical record could not reliably determine the specific aneurysm responsible for the rupture. RESULTS In total there were 784 females and 472 males with a female/male ratio of 1.66. The female/male ratio was down to 0.50 for patients younger than 35 yrs. For both males and females, aneurysm rupture was most common during the age of 50-59 yrs. Ruptured aneurysms were mostly of 2 mm-5 mm in size (47.1%), followed by 5 mm-10 mm (39.7%). Ruptured single cerebral aneurysm occurred in anterior circulation in 95.0% of the cases, with 5.0% occurred in posterior circulation. Ruptured aneurysm most commonly occurred at posterior communicating artery (34.9%) and anterior communicating artery (29.5%). 183 cases (14.6%) had multiple aneurysms. CONCLUSIONS With younger patients, there is a male predominance in our series. Ninety percent of patients have ruptured aneurysms less than 10 mm in size.
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Affiliation(s)
- Lin Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Lihong Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- * E-mail: (LZ); (YXJW)
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhenzhong Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Linwei Tian
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yi-Xiang J. Wang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail: (LZ); (YXJW)
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Crobeddu E, Panciani PP, Garbossa D, Pilloni G, Fornaro R, Ronchetti G, Spena G, Tartara F, Ducati A, Fontanella M. Cerebrovascular diseases in the elderly: the challenge of multiple aneurysms. Int J Neurosci 2014; 124:573-6. [PMID: 24325388 DOI: 10.3109/00207454.2013.873797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The worldwide population aging and the nowadays medical advances impose to consider new management guidelines for elderly. Aim of this study was to assess the best treatment in elderly with multiple intracranial aneurysms (MIA). METHODS From 1994 to 2011, we admitted 1462 patients with ruptured cerebral aneurysm. Among those aged ≥65 years, 43 had MIA (15% of elderly). Size and aneurysm location, timing and type of treatment were analyzed. Patients were thus stratified according to Hunt-Hess grade on admission and evaluated at 6 months using the Glasgow Outcome Scale (GOS). RESULTS We had 87 aneurysms in the final series. Three patients died because of the impossibility to treat the ruptured aneurysm. No new bleeding from untreated aneurysms was observed; no retreatment after previous coiling was performed. CONCLUSIONS MIA lead to significantly poorer outcomes, especially in elderly, because of their general clinical condition, presence of risk factors and lower capacity of reaction to stressful events. In patients without large hematomas, coiling of the ruptured aneurysm represents the procedure with high effectiveness. The clinical conditions on admission represent the most important factor for the treatment results. To reduce the treatment-related risks we do recommend a conservative approach for the unruptured aneurysms.
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Affiliation(s)
- Emanuela Crobeddu
- Department of Neuroscience, Division of Neurosurgery, 1University of Torino, 2University of Brescia, Torino and Brescia, Italy
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Wang R, Zhang D, Zhao J, Wang S, Zhao Y, Niu H. A comparative study of 43 patients with mirror-like intracranial aneurysms: risk factors, treatment, and prognosis. Neuropsychiatr Dis Treat 2014; 10:2231-7. [PMID: 25429221 PMCID: PMC4242700 DOI: 10.2147/ndt.s70515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Mirror-like intracranial aneurysms (MirAn) occur symmetrically at the corresponding intracranial arteries and are a subgroup of multiple intracranial aneurysms. The aim of this study was to analyze the risk factors, treatment, and prognosis of MirAn. METHODS We retrospectively analyzed 43 cases of MirAn diagnosed between January 2000 and December 2009. The control groups comprised patients with non-mirror-like multiple aneurysms (nMirAn) and single aneurysms (SingAn). Sex, age, localization of MirAn, hypertension, diabetes, smoking, and rupture were identified as potential risk factors for MirAn. RESULTS The male to female ratio of the MirAn patients was 1.0:5.1, which was significantly different from that of the nMirAn patients (1.0:1.9, P=0.037) and SingAn patients (1.0:1.3, P<0.001). There was no difference in age (P=0.8741), smoking (P=0.301), diabetes (P=0.267), or hypertension (P=0.874) between the MirAn and nMirAn patients. The aneurysms in 28 MirAn patients (65.1%) involved the internal carotid-posterior communicating arteries; in these patients, the rupture risk was significantly higher for larger aneurysms compared with smaller aneurysms (P<0.05). CONCLUSION More women suffered from MirAn than nMirAn or SingAn. The most common MirAn sites were the internal carotid-posterior communicating arteries. Our results suggest that MirAn was not associated with age, smoking, hypertension, or diabetes.
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Affiliation(s)
- Rong Wang
- Neurosurgical Department, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Dong Zhang
- Neurosurgical Department, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Jizong Zhao
- Neurosurgical Department, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Shuo Wang
- Neurosurgical Department, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Yuanli Zhao
- Neurosurgical Department, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Hongchuan Niu
- Capital Medical University, Beijing, People's Republic of China
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Pulsed estrogen therapy prevents post-OVX porcine dura mater microvascular network weakening via a PDGF-BB-dependent mechanism. PLoS One 2013; 8:e82900. [PMID: 24349391 PMCID: PMC3857298 DOI: 10.1371/journal.pone.0082900] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/05/2013] [Indexed: 11/19/2022] Open
Abstract
In postmenopausal women, estrogen (E2) deficiencies are frequently associated with higher risk of intracranial hemorrhage, increased incidence of stroke, cerebral aneurysm, and decline in cognitive abilities. In younger postpartum women and those using oral contraceptives, perturbations in E2 are associated with higher risk of cerebral venous thrombosis. A number of serious intracranial pathologic conditions linked to E2 deficiencies, such as dural sinus thrombosis, dural fistulae, non-parenchymal intracranial hemorrhages, migraines, and spontaneous cerebrospinal fluid leaks, involve the vessels not of the brain itself, but of the outer fibrous membrane of the brain, the dura mater (DM). The pathogenesis of these disorders remains mysterious and how estrogen regulates structural and functional integrity of DM vasculature is largely unknown. Here, we demonstrate that post ovariectomy (OVX) DM vascular remodeling is manifested by microvessel destabilization, capillary rarefaction, increased vascular permeability, and aberrant angio-architecture, and is the result of disrupted E2-regulated PDGF-BB signaling within dura microvasculature. These changes, associated with the reduction in systemic PDGF-BB levels, are not corrected by a flat-dose E2 hormone replacement therapy (HRT), but are largely prevented using HRT schedules mimicking physiological E2 fluctuations. We demonstrate that 1) E2 regulates PDGF-BB production by endothelial cells in a dose-dependent manner and 2) optimization of PDGF-BB levels and induction of robust PDGF-mediated endothelial cell-vascular pericyte interactions require high (estrous) E2 concentrations. We conclude that high (estrous) levels of E2 are important in controlling PDGF-mediated crosstalk between endothelial cells and pericytes, a fundamental mechanism governing microvessel stability and essential for preserving intracranial homeostasis.
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Lee Y, Min HK, Yoon SP. Anterior cerebral artery aneurysm associated with multiple intracranial aneurysms and abdominal aorta aneurysm. Anat Cell Biol 2013; 46:220-2. [PMID: 24179699 PMCID: PMC3811850 DOI: 10.5115/acb.2013.46.3.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 11/27/2022] Open
Abstract
We found multiple aneurysms in the intracranial arteries and abdominal aorta of an 87-year-old Korean female cadaver, whose cause of death was reported as "cholangiocarcinoma." An abdominal aortic aneurysm was observed in the infrarenal aorta, where the inferior mesenteric artery arose. The intracranial aneurysms were found in the A3 segment of the anterior cerebral artery and at the bifurcation of the middle cerebral artery. This case provides an example of the very rare association of peripheral intracranial aneurysms with an abdominal aortic aneurysm. Clinicians as well as anatomists should recognize the potential association between these two aneurysm types.
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Affiliation(s)
- Yunghwan Lee
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
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Oh K, Lim YC. Single-session Coil Embolization of Multiple Intracranial Aneurysms. J Cerebrovasc Endovasc Neurosurg 2013; 15:184-90. [PMID: 24167798 PMCID: PMC3804656 DOI: 10.7461/jcen.2013.15.3.184] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 08/24/2013] [Accepted: 08/28/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE There is no clear treatment strategy for the management of multiple intracranial aneurysms because of variable anatomical distribution, difficult identification of the aneurysm ruptured, and poor overall outcomes. The purpose of this study was to assess the efficacy and safety of single-session coil embolization for multiple intracranial aneurysms. METHODS Between September 2008 and December 2012, 209 aneurysms in 117 patients were treated at our institute. Twenty eight among the 117 patients had multiple aneurysms with a total of 71, and 60 of the 71 aneurysms underwent coil embolization in a single-session. RESULTS A total of 60 aneurysms were treated with a single-session coil embolization, of which the most frequent locations were in the posterior communicating artery, followed by the middle cerebral artery. Immediate post-embolization angiographies showed total occlusion in 49 (81.7%) aneurysms, remnant neck in 6 (10%), and body-filling in 5 (8.3%). Procedure-related complications had developed in 2 (3.3%) of the 60 embolized aneurysms: an asymptomatic thromboembolic event, and a partial coil protrusion without a subsequent thromboembolic complication. CONCLUSION With careful evaluation of individual aneurysm characteristics and configuration, multiple intracranial aneurysms previously thought to require multimodality therapy can be safely treated in a single-session coil embolization.
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Affiliation(s)
- Keun Oh
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
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Oshino S, Nishino A, Suzuki T, Arita H, Tateishi A, Matsumoto K, Shimokawa T, Kinoshita M, Yoshimine T, Saitoh Y. Prevalence of cerebral aneurysm in patients with acromegaly. Pituitary 2013; 16:195-201. [PMID: 22752346 DOI: 10.1007/s11102-012-0404-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The prevalence of cerebral aneurysm was retrospectively investigated in 208 patients with acromegaly relative to the rate of cerebral aneurysm in a group of control subjects. Neuroradiological examinations of the cerebral vascular system were conducted in 208 acromegaly patients (101 men; mean age, 48.8 years). The prevalence of cerebral aneurysm in the acromegaly patients was compared to that in a control group consisting of 7,390 subjects who underwent "brain checkup" between 2006 and 2008 (mean age, 51.6 years). In the acromegaly group, cerebral aneurysm was detected in 4.3 % of patients. By sex, the prevalence was 6.9 % in males, a significantly proportion than that in the control group with an odds ratio of 4.40. The prevalence in females did not differ between the two groups. In the acromegaly group, the rate of hypertension was significantly higher in the patients with aneurysm compared to those without aneurysm. Multiple logistic regression identified acromegaly as a significant factor related to the prevalence of cerebral aneurysm in all male subjects; other factors, such as age, hypertension and smoking, were not found to be significant. A significantly higher prevalence of cerebral aneurysm was detected in male patients with acromegaly. This finding indicates that excess growth hormone or insulin-like growth factor 1 affects the cerebral vascular wall, resulting in aneurysm formation. In addition to known systematic complications in the cardiovascular, respiratory, metabolic, and other systems, the risk of cerebral aneurysm should be considered in the management of acromegaly.
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Affiliation(s)
- Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Francis SE, Tu J, Qian Y, Avolio AP. A combination of genetic, molecular and haemodynamic risk factors contributes to the formation, enlargement and rupture of brain aneurysms. J Clin Neurosci 2013; 20:912-8. [PMID: 23726520 DOI: 10.1016/j.jocn.2012.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 12/03/2012] [Accepted: 12/08/2012] [Indexed: 12/20/2022]
Abstract
Many people carry cerebral aneurysms but are generally unaware of their presence until they rupture, resulting in high morbidity or mortality. The pathogenesis and aetiology of aneurysms are largely unknown; however, a greater understanding, by analysing the genetic, molecular and haemodynamic risk factors involved in the initiation, enlargement, and rupture of aneurysms, could lead to effective prevention, early diagnosis and more effective treatment. The risk of aneurysm is increased by a family history of aneurysms, and amongst certain populations, namely in Japan and Finland. Several other risk factors are documented, including hypertension, smoking, alcohol consumption, and female sex. Studies indicate a higher occurrence of cerebral aneurysms in females compared to males. Oestrogen protects several components within the artery wall, and inhibits some of the inflammatory molecules that could cause aneurysms. At menopause, the oestrogen level decreases and the incidence of aneurysm increases. Haemodynamic stresses have been shown to be involved in the formation, growth and rupture of aneurysms. This is often associated with hypertension, which also increases the risk of aneurysm rupture. When an unruptured aneurysm is detected the decision to treat can be complicated, since only 1-2% of aneurysms eventually rupture. Haemodynamic simulation software offers an effective tool for the consideration of treatment options for patients who carry unruptured aneurysms. The assessment must consider the risks of interventional treatments versus non-interventional management options, such as controlling blood pressure.
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Affiliation(s)
- Sheila E Francis
- Australian School of Advanced Medicine, Macquarie University, 75 Talavera Road, North Ryde, New South Wales 2109, Australia
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Abstract
Acute subarachnoid hemorrhage (SAH) is a severe and acute life-threatening cerebrovascular disease. Approximately 80% of all acute non-traumatic SAHs are the result of a ruptured cerebrovascular aneurysm. Despite advances in diagnosis and treatment a high morbidity and mortality still exists. Apart from the primary cerebral damage there are also secondary complications, such as vasospasm, rebleeding, hydrocephalus, cerebral edema or hydrocephalus. For an appropriate therapy an understanding of the extensive pathophysiology, the options in diagnostics and therapy and the complications of the disease are essential. Anesthesiologists are decisively involved in the therapy of the primary and secondary damages and subsequently in the outcome as well. This article provides an overview of the perioperative and intensive care management of patients with SAH.
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CHOTAI S, AHN SY, MOON HJ, KIM JH, CHUNG HS, CHUNG YG, KWON TH. Prediction of Outcomes in Young Adults With Aneurysmal Subarachnoid Hemorrhage. Neurol Med Chir (Tokyo) 2013; 53:157-62. [DOI: 10.2176/nmc.53.157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Silky CHOTAI
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine
| | - Sung-Yong AHN
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine
| | - Hong-Joo MOON
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine
| | - Jong-Hyun KIM
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine
| | - Heung-Seob CHUNG
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine
| | - Yong-Gu CHUNG
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine
| | - Taek-Hyun KWON
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine
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Lu HT, Tan HQ, Gu BX, Wu-Wang, Li MH. Risk factors for multiple intracranial aneurysms rupture: a retrospective study. Clin Neurol Neurosurg 2012; 115:690-4. [PMID: 22921040 DOI: 10.1016/j.clineuro.2012.08.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 07/10/2012] [Accepted: 08/03/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The presence of predicting the rupture risk of intracranial aneurysms has recently generated considerable controversy. We retrospectively investigated the risk factors for multiple intracranial aneurysms related to rupture. METHODS Between July 2007 and July 2011, 134 patients with 294 aneurysms were identified after review. Every patient had two or more aneurysms. Univariate and multivariate logistic regression models were used to analyze the risk factors for multiple intracranial aneurysms with age, gender, site and size. RESULTS 134 patients were divided into three groups according to patient age category (<45, 45-65, >65 years of age). The incidence of aneurysms ruptured in the second group was significantly higher. Three groups showed significant difference (P=0.001 versus >65 years of age). Thirteen of 35 AComA aneurysms were ruptured, accounting for 26% of all ruptured aneurysms, and the rate of rupture at AComA aneurysms in patients was 37.1%. The rate of aneurysm rupture in the AComA was significantly higher than that in other sites (P=0.001). In all 294 aneurysms, 88.1% of the aneurysms were 5mm or less, of which 58.2% were less than 3mm. In the ruptured aneurysms, 68% were 5mm or less. CONCLUSIONS Our study reveals the pattern of ruptured multiple intracranial aneurysms, in terms of age, size and location of aneurysms. Age, size, and site of aneurysm should be considered in the decision whether to treat an unruptured aneurysm or not. Especially, in cases of multiple aneurysm, the AComA aneurysm is most prone to hemorrhage.
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Affiliation(s)
- Hai-Tao Lu
- Institute of Interventional and Diagnostic Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai 200233, China
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Ding C, Toll V, Ouyang B, Chen M. Younger age of menopause in women with cerebral aneurysms. J Neurointerv Surg 2012; 5:327-31. [DOI: 10.1136/neurintsurg-2012-010364] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ghods AJ, Lopes D, Chen M. Gender differences in cerebral aneurysm location. Front Neurol 2012; 3:78. [PMID: 22661965 PMCID: PMC3356859 DOI: 10.3389/fneur.2012.00078] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 04/23/2012] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress. This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there exists a gender discrepancy in the anatomic distribution of cerebral aneurysms. Methods: A retrospective review of consecutive patients with ruptured and unruptured intradural saccular cerebral aneurysms treated endovascularly was performed. Results: Six hundred eighty-two aneurysms were treated. Seventy-two percentage of the patients were women and 27% of patients presented with SAH. Among women, most aneurysms were located along the ICA (54%) while men the ACA (29%, compared to 15% in women), a discrepancy evident in both unruptured and ruptured groups. Females tended to present later in life (59 vs. 55 years), with multiple aneurysms (11 vs. 6% in men), and with SAH (28 vs. 23% in men) – the majority of these ruptured aneurysms were located at the ICA (42%), while men at the ACA (47%). Additionally, the majority (68%) of ruptured ICA aneurysms were PCOM. Conclusion: Understanding the natural history of aneurysms is imperative in treating incidentally found aneurysms. Significant differences exist between the genders in relation to aneurysm location, the most pronounced at the ICA and ACA. Previously described hormonal and hemodynamic theories behind cerebral aneurysm pathogenesis seem like plausible reasons to explain these differences.
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Affiliation(s)
- Ali J Ghods
- Department of Neurosurgery, Rush University Medical Center Chicago, IL, USA
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Meissner I, Torner J, Huston J, Rajput ML, Wiebers DO, Jones LK, Brown RD. Mirror aneurysms: a reflection on natural history. J Neurosurg 2012; 116:1238-41. [PMID: 22404675 DOI: 10.3171/2012.1.jns11779] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Investigators conducting the International Study of Unruptured Intracranial Aneurysms, sponsored by the National Institutes of Health, sought to evaluate predictors of future hemorrhage in patients who had unruptured mirror aneurysms. These paired aneurysms in bilateral arterial positions mirror each other; their natural history is unknown. METHODS Centers in the US, Canada, and Europe enrolled patients for prospective assessment of unruptured intracranial aneurysms. Central radiological review confirmed the presence or absence of mirror aneurysms in patients without a history of prior subarachnoid hemorrhage (SAH) (Group 1). Outcome at 1 and 5 years and aneurysm characteristics are compared. RESULTS Of 3120 patients with aneurysms treated in 61 centers, 376 (12%) had mirror aneurysms, which are more common in women than men (82% [n = 308] vs 73% [n = 1992], respectively; p <0.001) and in patients with a family history of aneurysm or SAH (p <0.001). Compared with patients with nonmirror saccular aneurysms, a greater percentage of patients with mirror aneurysms had larger (>10 mm) aneurysms (mean maximum diameter 11.7 vs 10.4 mm, respectively; p <0.001). The most common distribution for mirror aneurysms was the middle cerebral artery (34% [126 patients]) followed by noncavernous internal carotid artery (32% [121]), posterior communicating artery (16% [60]), cavernous internal carotid artery (13% [48]), anterior cerebral artery/anterior communicating artery (3% [13]), and vertebrobasilar circulation (2% [8]). When these patients were compared with patients without mirror aneurysms, no statistically significant differences were found in age (mean age 54 years in both groups), blood pressure, smoking history, or cardiac disease. Aneurysm rupture rates were similar (3.0% for patients with mirror aneurysms vs 2.8% for those without). CONCLUSIONS Overall, patients with mirror aneurysms were more likely to be women, to report a family history of aneurysmal SAH, and to have larger aneurysms. The presence of a mirror aneurysm was not an independent predictor of future SAHs.
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Affiliation(s)
- Irene Meissner
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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74
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Jou LD, Morsi H, Shaltoni HM, Mawad ME. Hemodynamics of small aneurysm pairs at the internal carotid artery. Med Eng Phys 2012; 34:1454-61. [PMID: 22410434 DOI: 10.1016/j.medengphy.2012.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 11/24/2011] [Accepted: 02/07/2012] [Indexed: 11/24/2022]
Abstract
Cerebral aneurysms carry significant risks because rupture-related subarachnoid hemorrhage leads to serious and often fatal consequences. The rupture risk increases considerably for multiple aneurysms. Multiple aneurysms can grow from the same location of an artery, and the interaction between these aneurysms raises the rupture risk even higher. Four aneurysm pair cases at the internal carotid artery are investigated for their hemodynamic behaviors using patient-specific modeling. For each case, aneurysms are separated from the parent artery and three models are reconstructed, one with two aneurysms and the other two models with only one of the two aneurysms. Results show that the relative anatomic location of one aneurysm to the other may determine the hemodynamic environment of an aneurysm. The presence of a proximal aneurysm reduces the intra-aneurysmal flow into the distal aneurysm; the proximal aneurysm and larger aneurysm have a greater area under low wall shear stress. The average intra-aneurysmal inflow ratio ranges from 16% to 41%, and reduction of the inflow ratio by an aneurysm pair varies from 6% to 15%. The maximum wall shear stress increases for serial aneurysms, but decreases for parallel aneurysms. Interaction between parallel aneurysms is not significant; however, the proximal aneurysm in serial aneurysms may be subject to a greater rupture risk.
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Affiliation(s)
- Liang-Der Jou
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030, United States.
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ter Laan M, Kerstjens-Frederikse WS, Metzemaekers JDM, van Dijk JMC, Groen RJM. Concordant Symptomatic Intracranial Aneurysm in a Monozygotic Twin: A Case Report and Review of the Literature. Twin Res Hum Genet 2012; 12:295-300. [DOI: 10.1375/twin.12.3.295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe development of an intracranial aneurysm (IA) is a multifactorial process, involving genetic and environmental factors. The presence of IA or aneurysmal subarachnoid hemorrhage (aSAH) in twins is particularly interesting, since both genetic and environmental factors can be studied. It also raises the question of whether, when one twin is affected, the other asymptomatic twin should be examined for an IA. We report on a monozygotic (MZ) twin-pair with aSAH in both twins and we review all reported cases of IA in MZ twins. Including our case, we found only 14 MZ twin-pairs in which both twins harbored an IA, suggesting a heavy underreporting in the medical literature. In this small group, a high concordance was noted in the sites of IAs. In MZ twins, the preferred sites for IAs are the branching arteries, while aneurysms arising from fusion arteries are rare. These sites differ from the preferential sites seen in series of familial IAs and series of sporadic IAs. We therefore hypothesize that the twinning process might play a significant role in the development of IAs in MZ twins. To further explore and substantiate this, the large twin registries should be studied. Although IAs in MZ twins with a negative family history for IAs should not be regarded as familial IAs, screening of the asymptomatic twin should be seriously considered if one MZ twin presents with an aSAH or an IA, because of the high fatality rates reported in asymptomatic (and not screened) MZ twin-halves.
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Zhang X, Long XA, Luo B, Karuna T, Duan CZ. Factors responsible for poor outcome after intraprocedural rerupture of ruptured intracranial aneurysms: Identification of risk factors, prevention and management on 18 cases. Eur J Radiol 2012; 81:e77-85. [DOI: 10.1016/j.ejrad.2011.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/02/2011] [Indexed: 11/28/2022]
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Chalouhi N, Chitale R, Jabbour P, Tjoumakaris S, Dumont AS, Rosenwasser R, Gonzalez LF. The case for family screening for intracranial aneurysms. Neurosurg Focus 2011; 31:E8. [DOI: 10.3171/2011.9.focus11210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Given that relatives of patients with intracranial aneurysms (IAs) or subarachnoid hemorrhage have a greater risk of harboring an aneurysm, family screening has become a common practice in neurosurgery. Unclear data exist regarding who should be screened and at what age and interval screening should occur. Multiple factors including the natural history of IAs, the risk of treatment, the cost of screening, and the psychosocial impact of finding an aneurysm should be taken into account when family screening is considered. In this paper, the authors review the current literature regarding risk factors and natural history of sporadic and familial aneurysms. Based on these data the authors assess current recommendations for screening and propose their own recommendations.
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Defillo A, Nussbaum ES, Zelensky A, Nussbaum L. Multiple non-branching dissecting aneurysms of the mid-basilar trunk presenting with sequential subarachnoid hemorrhages. Surg Neurol Int 2011; 2:127. [PMID: 22059122 PMCID: PMC3205486 DOI: 10.4103/2152-7806.85059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/22/2011] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We describe a rare case of a patient with subarachnoid hemorrhage (SAH) due to a ventral dissecting mid-basilar aneurysm that was treated surgically. One week after surgery, the patient experienced sudden deterioration due to a new SAH caused by the development of a new aneurysm of the basilar trunk distinct from the previously clipped aneurysm. CASE DESCRIPTION A 54-year-old woman with acute subarachnoid hemorrhage was found to have a small, broad-based aneurysm arising from the ventral aspect of the mid-basilar artery. This complicated lesion was treated with a microsurgical clipping via a translabyrinthine pre-sigmoidal sub-temporal approach. One week postoperatively, the patient suffered a new SAH and was found to have developed a distinct basilar artery aneurysm. The patient was returned to the Operating Room for microsurgical clipping via the previous craniotomy. After surgery, the patient made a slow, but steady, recovery. She underwent repeated angiographic imaging, demonstrating a stable appearance. Two years post surgery, the patient had returned to work and had no obvious neurological deficit, with the exception of unilateral iatrogenic hearing loss. CONCLUSION We describe a rare case of multiple aneurysms originating in relation to a mid-basilar dissection, resulting in multiple episodes of SAH. These are difficult and dangerous lesions that can be treated with open microsurgical reconstruction or possibly via an endovascular approach. The intricate location of the lesions poses a particular challenge to neurosurgeons attempting to directly treat mid-basilar lesions.
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Affiliation(s)
- Archie Defillo
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
| | - Eric S. Nussbaum
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
| | - Andrea Zelensky
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
| | - Leslie Nussbaum
- Department of Neurosurgery, National Brain Aneurysm Center, Health East St. Joseph's Hospital, St. Paul, MN 55102, USA
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Hillbom M, Saloheimo P, Juvela S. Alcohol Consumption, Blood Pressure, and the Risk of Stroke. Curr Hypertens Rep 2011; 13:208-13. [DOI: 10.1007/s11906-011-0194-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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80
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Non-aneurysm subarachnoid hemorrhage in young adults. ACTA NEUROCHIRURGICA. SUPPLEMENT 2010. [PMID: 21116941 DOI: 10.1007/978-3-7091-0353-1_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
OBJECTIVE The incidence of subarachnoid hemorrhage (SAH) in the young is increasing recently. Among the young patients, some of them do not have detectable aneurysms, so the cause of the disease may be non-aneurysmal. In this study, we analyzed some clinical cases of subarachnoid hemorrhage in young adults and discussed the possible causes other than present aneurysm and arteriovenous malformation (AVM). METHODS We reviewed 11 patients with SAH below 45 years of age enrolled in our hospital from January 2007 to June 2008. Their clinical characteristics, imaging examination results were analyzed in details: nine patients were found with no obvious cause for their hemorrhage. Four of them were followed up for 1 year and the other three were followed up for half a year. We telephoned the seven patients to gain the information on their recovery by questionnaire. RESULTS With an average onset age of 38 years old, all patients had similar symptoms and onset behavior according to their clinical characteristics. Based on the imaging results, two had confirmed vascular malformation; the other nine did not present detectable aneurysm or AVM, but with different morphological changes of their cerebral arteries. By 1-year or half-year follow-up, the seven patients were found to have good recovery. CONCLUSION Pathological changes of cerebral vessels due to smoking, genetic, or as an early version of formation of aneurysm, might be contributed to SAH in the young. Repeated angiogram is necessary for young patients to confirm the cause of SAH.
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Biomarkers of connective tissue disease in patients with intracranial aneurysms. J Clin Neurosci 2010; 17:1119-21. [DOI: 10.1016/j.jocn.2010.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/22/2009] [Accepted: 01/05/2010] [Indexed: 11/22/2022]
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Lehecka M, Dashti R, Lehto H, Kivisaari R, Niemelä M, Hernesniemi J. Distal Anterior Cerebral Artery Aneurysms. SURGICAL MANAGEMENT OF CEREBROVASCULAR DISEASE 2010; 107:15-26. [DOI: 10.1007/978-3-211-99373-6_3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan. Acta Neurochir (Wien) 2009; 151:1623-30. [PMID: 19669689 DOI: 10.1007/s00701-009-0479-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND A community-based study was conducted to estimate the incidence rates of multiple aneurysms and to investigate the factors related to multiplicity. METHOD The subjects were 291 patients with ruptured saccular aneurysms treated between 1980 and 1998, in Izumo, Japan. There were 403 aneurysms in total, and 78 patients (27%) had multiple aneurysms. FINDINGS Both the crude and the age- and sex-adjusted annual incidence rates per 100,000 population for multiple and single aneurysms were five and 14 for all ages, respectively, and were higher in women than in men. The age-specific incidence rates of both multiple and single aneurysms showed a tendency to increase with age. Of the 190 patients who underwent four-vessel studies, 26% (49) had multiple aneurysms. The frequencies of multiple aneurysms in patients with ruptured aneurysms > or =10 and <10 mm in diameter were 41% and 21%, respectively (p = 0.0081). In patients with multiple aneurysms, the number of aneurysms was greater in those with large ruptured aneurysms, and the unruptured aneurysms tended to be larger in patients with large ruptured aneurysms. The size of the ruptured aneurysms was positively associated with multiplicity, whereas hypertension had an inverse association. Age, sex, aneurysm site and risk factors other than hypertension were not predictive. CONCLUSIONS This study is the first to provide annual incidence rates for multiple aneurysms in a defined population. It appears that multiplicity of aneurysms is associated with larger ruptured aneurysms and that patients with larger ruptured aneurysms have a higher number of aneurysms as well as larger unruptured aneurysms.
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Inagawa T. Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane, Japan. World Neurosurg 2009; 73:155-64; discussion e23. [PMID: 20860953 DOI: 10.1016/j.surneu.2009.03.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 03/05/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prevention of aneurysmal subarachnoid hemorrhage (SAH) can be achieved by reducing risk factors, which include those for aneurysm formation and aneurysm rupture. However, neither of these 2 factors has been discussed separately so far. A case control study was undertaken in Shimane, Japan, to identify modifiable risk factors for the formation and rupture of aneurysms. METHODS This study included 858 patients with ruptured aneurysms, 285 patients with unruptured aneurysms without a history of SAH, and 798 control subjects. Hypertension, diabetes mellitus, heart disease, hypercholesterolemia, cigarette smoking, and alcohol consumption were assessed as risk factors by using conditional logistic regression. RESULTS After adjustment for other risk factors, hypertension was the most powerful risk factor for aneurysm formation, regardless of age and sex, followed by hypercholesterolemia, heart disease, and cigarette smoking, whereas diabetes mellitus and daily drinking were insignificant for aneurysm formation. Hypertension and daily drinking were not related to the risk of aneurysm rupture, regardless of age and sex, whereas cigarette smoking was associated with an increased risk of aneurysm rupture in patients 60 years or older and in men. In contrast, hypercholesterolemia was strongly associated with a decreased risk of rupture, regardless of age and sex, and in patients with small aneurysms (<5 mm). Diabetes mellitus and heart disease were also related to a decreased risk of rupture in patients 60 years or older and in women. CONCLUSION Identification of risk factors for aneurysm formation and rupture separately seems to be pivotal for reducing the incidence of SAH.
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Affiliation(s)
- Tetsuji Inagawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo 693-8555, Japan.
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85
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Unilateral approach to clip bilateral multiple intracranial aneurysms. ACTA ACUST UNITED AC 2009; 72 Suppl 1:S23-8; discussion S28. [DOI: 10.1016/j.surneu.2007.12.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 12/26/2007] [Indexed: 11/22/2022]
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Abstract
OBJECTIVE Acute aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted disorder that plays out over days to weeks. Many patients with SAH are seriously ill and require a prolonged intensive care unit stay. Cardiopulmonary complications are common. The management of patients with SAH focuses on the anticipation, prevention, and management of these secondary complications. DATA SOURCES Source data were obtained from a PubMed search of the medical literature. DATA SYNTHESIS AND CONCLUSION The rupture of an intracranial aneurysm is a sudden devastating event with immediate neurologic and cardiac consequences that require stabilization to allow for early diagnostic angiography. Early complications include rebleeding, hydrocephalus, and seizures. Early repair of the aneurysm (within 1-3 days) should take place by surgical or endovascular means. During the first 1-2 weeks after hemorrhage, patients are at risk of delayed ischemic deficits due to vasospasm, autoregulatory failure, and intravascular volume contraction. Delayed ischemia is treated with combinations of volume expansion, induced hypertension, augmentation of cardiac output, angioplasty, and intra-arterial vasodilators. SAH is a complex disease with a prolonged course that can be particularly challenging and rewarding to the intensivist.
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Bederson JB, Connolly ES, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE, Harbaugh RE, Patel AB, Rosenwasser RH. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40:994-1025. [PMID: 19164800 DOI: 10.1161/strokeaha.108.191395] [Citation(s) in RCA: 911] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Intracranial aneurysms (IAs) are the dilatations of blood vessels in the brain and pose potential risk of rupture leading to subarachnoid hemorrhage. Although the genetic basis of IAs is poorly understood, it is well-known that genetic factors play an important part in the pathogenesis of IAs. Therefore, the identifying susceptible genetic variants might lead to the understanding of the mechanism of formation and rupture of IAs and might also lead to the development of a pharmacological therapy. To elucidate the molecular pathogenesis of diseases has become a crucial step in the development of new treatment strategies. Although extensive genetic research and its potential implications for future prevention of this often fatal condition are urgently needed, efforts to elucidate the susceptibility loci of IAs are hindered by the issues bewildering the most common and complex genetic disorders, such as low penetrance, late onset, and uncertain modes of inheritance. These efforts are further complicated by the fact that many IA lesions remain asymptomatic or go undiagnosed. In this review, we present and discuss the current status of genetic studies of IAs and we recommend comprehensive genome-wide association studies to identify genetic loci that underlie this complex disease.
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Affiliation(s)
- Jun Zhang
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Richard E. Claterbuck
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Patient and aneurysm characteristics in multiple intracranial aneurysms. CHANGING ASPECTS IN STROKE SURGERY: ANEURYSMS, DISSECTIONS, MOYAMOYA ANGIOPATHY AND EC-IC BYPASS 2008; 103:19-28. [DOI: 10.1007/978-3-211-76589-0_6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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90
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Lehecka M, Lehto H, Niemelä M, Juvela S, Dashti R, Koivisto T, Ronkainen A, Rinne J, Jääskeläinen JE, Hernesniemi JA. Distal anterior cerebral artery aneurysms: treatment and outcome analysis of 501 patients. Neurosurgery 2008; 62:590-601; discussion 590-601. [PMID: 18425008 DOI: 10.1227/01.neu.0000317307.16332.03] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study presents the combined experience of two Finnish neurosurgical centers in the treatment of 501 consecutive patients with distal anterior cerebral artery (DACA) aneurysms. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general and to identify factors predicting the outcome. METHODS We analyzed the clinical and radiological data of all 501 patients and focused on the 427 patients treated between 1980 and 2005, the era of microsurgery and computed tomographic imaging. No patients were lost to follow-up. We compared treatment and outcome of ruptured DACA aneurysms (n = 277) with all consecutive ruptured aneurysms from the Kuopio Cerebral Aneurysm Database (n = 2243) and used multivariate analysis to identify factors predicting 1-year outcome. RESULTS DACA aneurysms accounted for 6% of all intracranial aneurysms. They were smaller (median, 6 versus 8 mm), more frequently associated with multiple aneurysms (35 versus 18%), and presented more often with intracerebral hematomas (53 versus 26%) than ruptured aneurysms in general. Their microsurgical treatment showed the same complication rates (treatment morbidity, 15%; treatment mortality, 0.4%) as for other ruptured aneurysms. At 1 year after subarachnoid hemorrhage, they had similar favorable outcome (Glasgow Coma Scale score >or=4) as other ruptured aneurysms (74 versus 69%), but their mortality rate was lower (13 versus 24%). Factors predicting unfavorable outcome for ruptured DACA aneurysms were advanced age, Hunt and Hess grade greater than or equal to III, rebleeding before treatment, intracerebral hematoma, intraventricular hemorrhage, and severe preoperative hydrocephalus. CONCLUSION Despite their specific features, with modern treatment methods, ruptured DACA aneurysms have the same favorable outcome and lower mortality at 1 year as ruptured aneurysms in general.
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Affiliation(s)
- Martin Lehecka
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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91
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Park SK, Kim JM, Kim JH, Cheong JH, Bak KH, Kim CH. Aneurysmal subarachnoid hemorrhage in young adults: a gender comparison study. J Clin Neurosci 2008; 15:389-92. [PMID: 18242092 DOI: 10.1016/j.jocn.2007.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 04/12/2007] [Accepted: 04/14/2007] [Indexed: 11/18/2022]
Abstract
Aneurysmal subarachnoid hemorrhage is uncommon in young adults. The aim of this study was to compare clinical characteristics of ruptured aneurysms between males and females in the third or fourth decade of life. We retrospectively investigated 301 patients who underwent surgery for ruptured cerebral aneurysms over 6 years. Among them, 53 patients were aged between 20-39 years. Clinical characteristics and related variables were compared between genders. In general, there was a favorable outcome in either gender (84.9%). There was a higher incidence of multiplicity and intraoperative rupture in females, as well as a significant difference in aneurysm location between genders (p=0.030, p=0.014, and p=0.027 respectively). Overall outcome was not different between the two groups. These results suggest that aneurysm formation may differ between genders.
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Affiliation(s)
- Sang Kyu Park
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, 249-1 Kyomun-dong, Guri, Gyeonggi-do, South Korea
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92
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93
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Jamous MA, Nagahiro S, Kitazato KT, Tamura T, Kuwayama K, Satoh K. Role of estrogen deficiency in the formation and progression of cerebral aneurysms. Part II: experimental study of the effects of hormone replacement therapy in rats. J Neurosurg 2006; 103:1052-7. [PMID: 16381192 DOI: 10.3171/jns.2005.103.6.1052] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The increased incidence of cerebral aneurysms in postmenopausal women appears to be related to low levels of circulating estrogen. Using a rat model of aneurysm induction, the authors found that oophorectomy increased the incidence of experimental cerebral aneurysms (Part I in this issue). In the current study they examined the effects of hormone replacement therapy (HRT) on the formation of cerebral aneurysms in rats. METHODS Forty-five female Sprague-Dawley rats were divided into three equal groups. The animals in Groups A and B were subjected to a cerebral aneurysm induction procedure (renal hypertension and right common carotid artery ligation) followed 1 month later by bilateral oophorectomy. After an additional week the rats in Group A received 17beta estradiol continuous-release pellets. The rats in Group C served as controls. Three months after the aneurysm induction procedure, all the rats were killed and vascular corrosion casts of their cerebral arteries were prepared and checked for aneurysmal changes. Using a scanning electron microscope, the authors recorded aneurysmal changes as endothelial changes alone (Stage I), endothelial changes with intimal pad elevation (Stage II), and saccular aneurysm formation (Stage III). Aneurysmal changes (Stages I, II, and III) occurred in one third of rats that had undergone oophorectomy and were receiving HRT (Group A), compared with 87% of the rats that had undergone oophorectomy but did not receive HRT (Group B). Although most of the aneurysmal changes identified in Group A rats were limited to Stage I or II, most changes in Group B animals were identified as saccular dilation (Stage III). CONCLUSIONS The findings demonstrated the significant protective role of estrogen against the formation and progression of cerebral aneurysms. It appears to be related to the beneficial effects of estrogen on the function and growth of endothelial cells, which play a major role in preserving the integrity of the vascular wall.
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Affiliation(s)
- Mohammad A Jamous
- Department of Neurosurgery, School of Medicine, The University of Tokushima, Tokushima City, Japan
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94
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95
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Nahed BV, DiLuna ML, Morgan T, Ocal E, Hawkins AA, Ozduman K, Kahle KT, Chamberlain A, Amar AP, Gunel M. Hypertension, Age, and Location Predict Rupture of Small Intracranial Aneurysms. Neurosurgery 2005. [DOI: 10.1227/01.neu.0000175549.96530.59] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Brian V. Nahed
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
| | - Michael L. DiLuna
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas Morgan
- Anylan Center for Human Genetics and Genomics and Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Eylem Ocal
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
| | - Abigail A. Hawkins
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
| | - Koray Ozduman
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
| | - Kristopher T. Kahle
- Anylan Center for Human Genetics and Genomics and Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Andrea Chamberlain
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
| | - Arun P. Amar
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
| | - Murat Gunel
- Department of Neurosurgery, Yale Brain Aneurysm and AVM Center, and Anylan Center for Human Genetics and Genomics, Yale University School of Medicine, New Haven, Connecticut
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96
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Inci S, Ozgen T. Multiple aneurysms of the anterior communicating artery: radiological and surgical difficulties. J Neurosurg 2005; 102:495-502. [PMID: 15796385 DOI: 10.3171/jns.2005.102.3.0495] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Multiple aneurysms of the anterior communicating artery (ACoA) occur rarely and have not been well investigated previously. The authors report on a consecutive series of six patients who each harbored multiple ACoA aneurysms. The radiological and surgical difficulties encountered in treating these complex and uncommon aneurysms are described and the pertinent literature is reviewed. METHODS Between October 1996 and August 2003, the authors surgically treated 146 patients with ACoA aneurysms. Six (4.1%) of these patients harbored multiple aneurysms of the ACoA. Four of these patients were men and two were women; their ages ranged from 36 to 72 years. Five patients had two aneurysms and one patient had three. All underwent surgery performed using the pterional approach. The clinical presentations, angiograms, intraoperative difficulties, and surgical results were retrospectively analyzed. All patients had premorbid hypertension. In two cases, the aneurysms were initially misdiagnosed as a single complex aneurysm based on routine cerebral angiograms, but special angiographic views demonstrated double aneurysms. In one case, multiple ACoA aneurysms could be identified using three-dimensional (3D) computerized tomography (CT) angiography. The size of the ACoA aneurysms ranged from 3 to 12 mm (mean 5.3 mm). A total of 13 ACoA aneurysms were successfully occluded in the six patients. Four patients were discharged in good condition, and two patients died. CONCLUSIONS Although multiple ACoA aneurysms are quite rare, the following points should be kept in mind. (1) In bilobular ACoA aneurysms, special angiographic projections and 3D CT angiography or 3D digital subtraction angiography should also be performed to obtain a correct diagnosis. The differentiation of two aneurysms from a bilobular aneurysm during the preoperative period is important for surgical planning. (2) Angiographically, detection of the ruptured aneurysm is often difficult. (3) Resection of the gyrus rectus is necessary to obtain a good operative exposure. 4) Clip selection and sequencing are important. Straight clips with short blades should be preferred to avoid narrowing of the surgeon's view and a collision between the clips.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, School of Medicine, University of Hacettepe, Ankara, Turkey.
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97
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Cheong JJY, Ghinea N, van Gelder JM. Estimating the annual rate of de novo multiple aneurysms: three statistical approaches. Neurosurg Focus 2004; 17:E8. [PMID: 15633985 DOI: 10.3171/foc.2004.17.5.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Individuals with unruptured intracranial aneurysms experience a higher rate of rupture if their history includes another aneurysm that has previously bled. The authors used systematic review and metaregression to estimate the annual rate of development of second de novo aneurysms after subarachnoid hemorrhage.
Methods
This investigation included studies in which more than 300 patients with intracranial aneurysms were described, and in which the age of the patients and the proportion with multiple aneurysms were documented. Studies describing delayed follow-up angiography that was performed after treatment of aneurysms were also reviewed.
Twenty studies were included in a between-study analysis. The univariate odds ratio (OR) for multiple intracranial aneurysms per year of age was 1.085 (95% confidence interval [CI] 1.015–1.165); this value was calculated using a hierarchical model for between-study heterogeneity. Five studies were included that provided age stratification. The estimated OR for multiple intracranial aneurysms per year was 1.011 (95% CI 1.005–1.018). Four follow-up studies were available.
Conclusions
According to the three different approaches (study-level, patient-level, and follow-up analyses), the estimated annual rates of development of de novo aneurysms were 1.62% (95% CI 0.28–3.59%), 0.28% (95% CI 0.12–0.49%), and 0.92% (95% CI 0.64–1.25%), respectively. The estimated annual rate of development of second de novo aneurysms ranged from 0.28 to 1.62%.
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Affiliation(s)
- James Ju Yong Cheong
- Department of Neurosurgery, South Western Sydney Area Health Service, University of New South Wales, Sydney, Australia
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98
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Kim YJ, Song KY. Endovascular coiling of multiple (more than four) intracranial aneurysms. Case report. Interv Neuroradiol 2004; 10:75-81. [PMID: 20587268 DOI: 10.1177/159101990401000110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 02/03/2004] [Indexed: 11/17/2022] Open
Abstract
SUMMARY The incidence of multiple intracranial aneurysms has been reported from 5% to 35%. But over four multiple aneurysms are extremely rare. Sometimes it is very difficult to draw a clear line between ruptured ones and unruptured others especially in multiple aneurysm cases with even distribution of subarachnoid haemorrhage on basal cistern. We present two cases of multiple aneurysms, more than four, which were successfully treated by endovascular coiling at the same time. Our experience suggests an endovascular procedure would be the gold standard of treatment for ruptured multiple intracranial aneurysms.
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Affiliation(s)
- Y J Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan; Korea -
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99
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Casimiro MV, McEvoy AW, Watkins LD, Kitchen ND. A comparison of risk factors in the etiology of mirror and nonmirror multiple intracranial aneurysms. ACTA ACUST UNITED AC 2004; 61:541-5. [PMID: 15165792 DOI: 10.1016/j.surneu.2003.08.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2002] [Accepted: 08/04/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pure mirror intracranial aneurysms represent a subgroup of multiple aneurysm patients where a congenital predisposition may play a major etiologic role. The aim of this study was to compare the pattern of prevalence of known risk factors for aneurysm disease between pure mirror and pure nonmirror multiple aneurysm populations. METHODS Clinical records of all patients with multiple intracranial aneurysms admitted to our institution between January 1985 and September 2001 were reviewed. Age, localization of aneurysms, gender, and history of cigarette smoking or hypertension were noted and compared using Fisher's exact test and logistic regression analysis. RESULTS There were 33 patients presented with pure mirror aneurysms (MirAn) and 49 with nonmirror multiple aneurysms (nMirAn). Average age of rupture occurred in the 5th decade in both groups. Female:male ratio was 3.1:1 in MirAn; 2.1:1 in nMirAn. In MirAn patients younger than 40 years it was 1:1. Smoking was the most prevalent risk factor in nMirAn (59.2%). In MirAn this was true only for patients in the 5th or 6th decades (65%), and hypertension was the most prevalent risk factor over that age (62.5%). A total of 80% of mirror aneurysm patients under 40 years had no known extrinsic risk factor, compared with 20% in nMirAn (p < 0.05). CONCLUSIONS Differences in the relative prevalence of risk factors between both groups supports the hypothesis of a different etiologic process occurring in mirror aneurysm disease. Early rupture in patients with no extrinsic risk factors lends support to the role of a congenital predisposition over degenerative causes in these patients.
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Affiliation(s)
- Miguel V Casimiro
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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100
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Vates GE, Zabramski JM, Spetzler RF, Lawton MT. Intracranial Aneurysms. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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