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Pettersson SD, Khorasanizadeh M, Maglinger B, Garcia A, Wang SJ, Taussky P, Ogilvy CS. Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020. World Neurosurg 2023; 178:233-240.e13. [PMID: 37562685 DOI: 10.1016/j.wneu.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile especially for elderly patients; however, the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time. METHODS A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests. RESULTS A total of 280 studies including 83,437 UIAs treated between 1987 and 2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years, and 70.7% were female. There was a significant increasing trend in the age of the treated patients over time (Spearman r: 0.250; P < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987. CONCLUSIONS The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that re-evaluation of certain UIA treatment decision scores may be of great interest.
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Affiliation(s)
- Samuel D Pettersson
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philipp Taussky
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Kaya V, Tahtabasi M, Yıldırım İO. Risk factors for the rupture of anterior communicating artery aneurysms: Coexistence of fetal-type posterior cerebral artery and A1 segment hypoplasia/agenesis. J Clin Neurosci 2023; 110:74-79. [PMID: 36822073 DOI: 10.1016/j.jocn.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To investigate the effect of the coexistence of fetal-type posterior communicating artery (fPCA) and anterior cerebral artery (ACA) A1 segment agenesis/hypoplasia on the rupture of an anterior communicating artery (AComA) aneurysm. MATERIALS AND METHODS A total of 216 patients consecutively presenting with AComA aneurysms between January 2014 and December 2021 on digital subtraction angiography were evaluated. Patients without three-dimensional rotational angiography images, those aged under 18 years, those with suspected mycotic aneurysms, and those with dissecting and giant aneurysms were excluded from the study. The aneurysms were divided into two groups as ruptured and non-ruptured. Hemodynamic filling patterns were classified into four different types. RESULTS The study included 192 AComA aneurysms, 44.8% (n = 86) ruptured and 55.2% (n = 106) non-ruptured. According to hemodynamic filling patterns, in type 1, the frequency of non-ruptured aneurysms was statistically significantly higher than that of ruptured aneurysms (39.5% vs 18.9%; p = 0.001). In type 4, where fPCA and ACA A1 segment agenesis/hypoplasia coexists, the frequency of ruptured aneurysms was significantly higher than that of non-ruptured aneurysms (10.5% vs 22.7%; p = 0.026). The most common aneurysm size range was 4-7 mm (n = 85; 44.3%). There was no statistically significant difference in size between the ruptured and non-ruptured aneurysms (p = 0.627). CONCLUSION According to the hemodynamic filling classification, we observed that the presence of type 4 filling pattern, i.e., the coexistence of ACA A1 segment agenesis/hypoplasia and fPCA, increased the risk of rupture in AComA aneurysms.
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Affiliation(s)
- Veysel Kaya
- Department of Radiology, Harran University-Faculty of Medicine, Sanliurfa, Turkey
| | - Mehmet Tahtabasi
- Department of Radiology, University of Health Sciences- Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey.
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Rigante L, Boogaarts HD, Bartels RHMA, Vart P, Aquarius R, Grotenhuis JA, Moudrous W, De Korte AM, de Vries J. Factors Associated with Subsequent Subarachnoid Hemorrhages in Patients with Multiple Intracranial Aneurysms. World Neurosurg 2021; 154:e185-e198. [PMID: 34246826 DOI: 10.1016/j.wneu.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Detection of multiple intracranial aneurysms (MIAs) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is common and the optimal management of the additional unruptured intracranial aneurysms (UIA) is often a matter of debate. We calculate the incidence and the factors associated with subsequent aSAHs from untreated additional aneurysms in a single-center group of patients with aSAH and MIAs. METHODS Charts of patients with MIAs admitted to our neurosurgery department for aSAH between January 2000 and March 2020 were retrospectively reviewed. Incidence rate and factors associated with subsequent aSAHs were calculated with univariable and multivariable analyses. RESULTS Of the unruptured aneurysms, 50% were preventively treated. During a median follow-up of 3 years, 20 of 174 patients (11.5%) presented with a second aSAH. Incidence of rupture of an additional untreated aneurysm was 18.05 per 1000 person/years (confidence interval, 10.69-30.47). Rupture incidence of an additional aneurysm located in the anterior circulation was 32.70 per 1000 person/years and 40.73 per 1000 person/years in the posterior circulation. Presence of untreated mirror and de novo aneurysms increased the risk of overall subsequent aSAHs by 16.9-fold and 7.6-fold, respectively. Most untreated additional aneurysms causing a subsequent aSAH were smaller than 7 mm (73.3%), with middle cerebral artery being the most frequent location (40.0%). CONCLUSIONS Incidence of subsequent aSAHs is high in patients with aSAH-MIA. Untreated mirror and de novo aneurysms are associated with higher rupture risk. Longer follow-up and prophylactic treatment of asymptomatic aneurysms at higher rupture risk are recommended to prevent the significant poor outcome of subsequent aSAHs.
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Affiliation(s)
- Luigi Rigante
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Priya Vart
- Department of Health Evidence and Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rene Aquarius
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J André Grotenhuis
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Walid Moudrous
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anthonius M De Korte
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Choi HH, Cho YD, Yoo DH, Lee J, Mun JH, An SJ, Kang HS, Cho WS, Kim JE, Han MH. Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options. Korean J Radiol 2018; 19:849-858. [PMID: 30174473 PMCID: PMC6082764 DOI: 10.3348/kjr.2018.19.5.849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/03/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Mirror aneurysms are generally considered as a subset of multiple aneurysms, defined as aneurysms occurring bilaterally and symmetrically on the same-named vessels. Although not infrequent, the characteristics of mirror aneurysms are not well studied. This investigation was conducted to elucidate the anatomic features of such lesions and examine treatment options. Materials and Methods A retrospective review was conducted, aimed at 172 patients treated for 344 mirror aneurysms between January 2007 and December 2015. Aneurysms of similar nature but in asymmetric locations on the same-named vessels were excluded. All available records were examined and lesion characteristics, as well as treatment outcomes were assessed. Results In study subjects (n = 172), mirror aneurysms most often involved middle cerebral artery bifurcation (n = 83), followed by a paraclinoid internal carotid artery (n = 50) and posterior communicating artery (n = 21). Most of the lesions (95.3%) measured ≤ 10 mm, and in 126 patients (74.6%), the size ratios were > 50%. Of the 344 aneurysms studied, coil embolization was undertaken in 217, surgical clipping in 62, and observation alone (no treatment) in 65. Coil embolization and surgical clipping were done bilaterally in 83 and 12 patients, respectively. In 12 patients, combined coiling and clipping were implemented on each side. Single-stage coil embolization of both the aneurysms was performed in 73 patients, with excellent post-procedural (85.6%) and follow-up (86.8%) occlusive results. There was no procedure-related morbidity or mortality. Conclusion By adopting different treatment strategies to different configurations and vascular sources, mirror aneurysms can be safely and effectively treated. If feasible, single-stage coil embolization should be considered as a reasonable treatment option for mirror aneurysms.
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Affiliation(s)
- Hyun Ho Choi
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeongjun Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea
| | - Jong Hyeon Mun
- Department of Neurosurgery, Kwangju Christian Hospital, Gwangju 61661, Korea
| | - Sang Joon An
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University of Korea College of Medicine, Incheon 22711, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
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Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D’Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schöni D, Goldberg J, Valsecchi D, Robert T, Maduri R, Seule MA, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Zumofen DW. Impact of Aneurysm Multiplicity on Treatment and Outcome After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2018; 84:E334-E344. [DOI: 10.1093/neuros/nyy331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/21/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Rita Achermann
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Schatlo Bawarjan
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Donato D’Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Andrea Ferrari
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco V Corniola
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Rodolfo Maduri
- Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Kristine A Blackham
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
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McDowell MM, Zhao Y, Kellner CP, Barton SM, Sussman E, Claassen J, Ducruet AF, Connolly ES. Demographic and clinical predictors of multiple intracranial aneurysms in patients with subarachnoid hemorrhage. J Neurosurg 2018; 128:961-968. [DOI: 10.3171/2017.1.jns162785] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPathophysiological differences that underlie the development and subsequent growth of multiple aneurysms may exist. In this study, the authors assessed the factors associated with the occurrence of multiple aneurysms in patients presenting with aneurysmal subarachnoid hemorrhage (SAH).METHODSConsecutive patients presenting with aneurysmal SAH between 1996 and 2012 were prospectively enrolled in the Subarachnoid Hemorrhage Outcome Project. Patients harboring 1, 2, or 3 or more aneurysms were stratified into groups, and the clinical and radiological characteristics of each group were compared using multivariate logistic regression.RESULTSOf 1277 patients with ruptured intracranial aneurysms, 890 had 1 aneurysm, 267 had 2 aneurysms, and 120 had 3 or more aneurysms. On multinomial regression using the single-aneurysm cohort as base case, risk factors for patients presenting with 2 aneurysms were female sex (relative risk ratio [RRR] 1.80, p < 0.001), higher body mass index (BMI) (RRR 1.02, p = 0.003), more years of smoking (RRR = 1.01, p = 0.004), and black race (RRR 1.83, p = 0.001). The risk factors for patients presenting with 3 or more aneurysms were female sex (RRR 3.10, p < 0.001), higher BMI (RRR 1.03, p < 0.001), aneurysm in the posterior circulation (RRR 2.59, p < 0.001), and black race (RRR 2.15, p = 0.001). Female sex, longer smoking history, aneurysms in the posterior circulation, BMI, and black race were independently associated with the development of multiple aneurysms in our adjusted multivariate multinomial model.CONCLUSIONSSignificant demographic and clinical differences are found between patients presenting with single and multiple aneurysms in the setting of aneurysmal SAH. These predictors of multiple aneurysms likely reflect a predisposition toward inflammation and endothelial injury.
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Affiliation(s)
| | - Yin Zhao
- 1Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | | | | | - Eric Sussman
- 3Department of Neurological Surgery, Stanford University, Stanford, California
| | - Jan Claassen
- 4Division of Neurocritical Care, Columbia University, New York, New York; and
| | - Andrew F. Ducruet
- 1Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
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7
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Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D'Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schöni D, Valsecchi D, Maduri R, Seule MA, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Zumofen DW, Fandino J, Colluccia D, Arrighi M, Venier A, Kuhlen DE, Robert T, Reinert M, Weyerbrock A, Hlavica M, Fournier JY, Raabe A, Beck J, Bervini D, Schaller K, Daniel RT, Starnoni D, Messerer M, Levivier M, Keller E, Regli L, Bozinov O, Finkenstaedt S, Remonda L, Stippich C, Gralla J, Kulcsar Z, Mendes-Pereira V, Ahlborn P, Smoll NR, Rohde V, Tok S, Baumann F, Kothbauer K, Kerkeni H, Dan-Ura H, Landolt H, Mostaguir K, Gasche Y, Sarrafzadeh A, Hildebrandt G, Winkler K, Woernle C, Bernays R. Predictors of Occurrence and Anatomic Distribution of Multiple Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2018; 111:e199-e205. [DOI: 10.1016/j.wneu.2017.12.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/29/2022]
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8
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Doddasomayajula R, Chung BJ, Mut F, Jimenez CM, Hamzei-Sichani F, Putman CM, Cebral JR. Hemodynamic Characteristics of Ruptured and Unruptured Multiple Aneurysms at Mirror and Ipsilateral Locations. AJNR Am J Neuroradiol 2017; 38:2301-2307. [PMID: 28982787 DOI: 10.3174/ajnr.a5397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/01/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Different hemodynamic patterns have been associated with aneurysm rupture. The objective was to test whether hemodynamic characteristics of the ruptured aneurysm in patients with multiple aneurysms were different from those in unruptured aneurysms in the same patient. MATERIALS AND METHODS Twenty-four mirror and 58 ipsilateral multiple aneurysms with 1 ruptured and the others unruptured were studied. Computational fluid dynamics models were created from 3D angiographies. Case-control studies of mirror and ipsilateral aneurysms were performed with paired Wilcoxon tests. RESULTS In mirror pairs, the ruptured aneurysm had more oscillatory wall shear stress (P = .007) than the unruptured one and tended to be more elongated (higher aspect ratio), though this trend achieved only marginal significance (P = .03, 1-sided test). In ipsilateral aneurysms, ruptured aneurysms had larger maximum wall shear (P = .05), more concentrated (P < .001) and oscillatory wall shear stress (P < .001), stronger (P < .001) and more concentrated inflow jets (P < .001), larger maximum velocity (P < .001), and more complex flow patterns (P < .001) compared with unruptured aneurysms. Additionally, ruptured aneurysms were larger (P < .001) and more elongated (P < .001) and had wider necks (P < .001) and lower minimum wall shear stress (P < .001) than unruptured aneurysms. CONCLUSIONS High wall shear stress oscillations and larger aspect ratios are associated with rupture in mirror aneurysms. Adverse flow conditions characterized by high and concentrated inflow jets; high, concentrated, and oscillatory wall shear stress; and strong, complex and unstable flow patterns are associated with rupture in ipsilateral multiple aneurysms. In multiple ipsilateral aneurysms, these unfavorable flow conditions are more likely to develop in larger, more elongated, more wide-necked, and more distal aneurysms.
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Affiliation(s)
- R Doddasomayajula
- From the Bioengineering Department (R.D., B.J.C., F.M., J.R.C.), George Mason University, Fairfax, Virginia
| | - B J Chung
- From the Bioengineering Department (R.D., B.J.C., F.M., J.R.C.), George Mason University, Fairfax, Virginia
| | - F Mut
- From the Bioengineering Department (R.D., B.J.C., F.M., J.R.C.), George Mason University, Fairfax, Virginia
| | - C M Jimenez
- Neurosurgery Department (C.M.J.), University of Antioquia, Medellin, Colombia
| | - F Hamzei-Sichani
- Department of Neurosurgery (F.H.-S.), Mt. Sinai Medical Center, New York, New York
| | - C M Putman
- Interventional Neuroradiology (C.M.P.), Inova Fairfax Hospital, Falls Church, Virginia
| | - J R Cebral
- From the Bioengineering Department (R.D., B.J.C., F.M., J.R.C.), George Mason University, Fairfax, Virginia
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9
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Jiang H, Weng YX, Zhu Y, Shen J, Pan JW, Zhan RY. Patient and aneurysm characteristics associated with rupture risk of multiple intracranial aneurysms in the anterior circulation system. Acta Neurochir (Wien) 2016; 158:1367-75. [PMID: 27165300 DOI: 10.1007/s00701-016-2826-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/28/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Multiple intracranial aneurysms (MIAs) are associated with poorer outcomes after rupture than are single intracranial aneurysms (SIAs). Although the risk factors for intracranial aneurysm rupture have been widely investigated, few studies have focused on MIAs. Thus, the present study aimed to determine whether there are differences in the patient and aneurysm characteristics between those with ruptured and unruptured anterior circulation MIAs (AC-MIAs). METHOD The present study included 97 patients with AC-MIAs (58 ruptured, 39 unruptured). Data regarding patient characteristics, aneurysm location, mirror aneurysms (MirAns), and bleb formations were collected from medical records and angiography images. Three-dimensional (3D) geometries generated with a 3D Slicer were evaluated to determine the range of morphological parameters. A univariate analysis was conducted to identify significant differences between the groups and receiver-operating characteristic (ROC) analyses were performed for each morphological parameter. RESULTS There are significantly fewer patients younger than 40 years of age in the ruptured group (P = 0.04); although the groups did not significantly differ with regard to smoking and hypertension, the ruptured group included significantly more current smokers who smoked more than 20 cigarettes per day (P = 0.025) and significantly more patients with a history of hypertension but an irregular use of anti-hypertensive medications (P = 0.043). Ruptured AC-MIAs were more likely to be located in the internal carotid artery (ICA) communicating artery (ICA C7) and anterior communicating artery (AComA; P = 0.000), to have formed a pair of MirAns (P = 0.001), and to have a bleb formation (P = 0.000). In terms of morphological parameters, the two groups differed significantly regarding aneurysm size (P = 0.000), neck width (P = 0.016), bottleneck factor (BNF; P = 0.000), height/width ratio (H/W; P = 0.031), aspect ratio (AR; P = 0.000) and size ratio (SR; P = 0.000). Additionally, the ROC analyses revealed that the optimal threshold size for rupture was 4.00 mm and that the SR had the highest area under the curve (AUC) value (0.826). CONCLUSIONS The present study found that current smokers who smoked more than 20 cigarettes per day and those with hypertension but an irregular use of anti-hypertensive medications were more likely to suffer from rupture. Aneurysm location and bleb formation were closely related to the rupture of AC-MIAs, and SR was a better predictor of AC-MIAs rupture status than size, neck width, BNF, H/W and AR. These findings should be verified by future prospective follow-up studies of AC-MIAs.
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Affiliation(s)
- Hao Jiang
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Yu-Xiang Weng
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Yu Zhu
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Jian Shen
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Jian-Wei Pan
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Ren-Ya Zhan
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China.
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10
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Ahmed O, Kalakoti P, Hefner M, Cuellar H, Guthikonda B. Seven Intracranial Aneurysms in One Patient: Treatment and Review of Literature. J Cerebrovasc Endovasc Neurosurg 2015; 17:113-9. [PMID: 26157691 PMCID: PMC4495085 DOI: 10.7461/jcen.2015.17.2.113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 10/17/2014] [Accepted: 03/19/2015] [Indexed: 11/23/2022] Open
Abstract
Before the advent of endovascular coiling, patients with multiple intracranial aneurysms were treated with surgical clipping; however, with the advancements in endovascular technology, intracranial aneurysms can be treated with surgical clipping and/or endovascular coiling. We describe a case of subarachnoid hemorrhage in a patient with 7 intracranial aneurysms. A 45-year-old female developed a sudden headache and left sided hemiparesis. Initial workup showed a subarachnoid hemorrhage in the right Sylvian fissure. Further angiographic workup showed 7 intracranial aneurysms (left and right middle cerebral artery bifurcation, right middle cerebral artery, anterior communicating artery, left posterior communicating artery, right posterior inferior cerebellar artery, and left superior cerebellar artery). The patient underwent two craniotomies for surgical clipping of the anterior circulation aneurysms and endovascular stent-assisted coils for the posterior circulation aneurysms. The need for anti-platelet agents for endovascular treatment of the posterior circulation aneurysms and clinical presentation warranted surgical clipping of the anterior circulation aneurysms prior to endovascular therapy. We describe a case report and decision making for a patient with multiple intracranial aneurysms treated with surgical clipping and endovascular coiling.
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Affiliation(s)
- Osama Ahmed
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Piyush Kalakoti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Matthew Hefner
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Hugo Cuellar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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11
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Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured. PLoS One 2015; 10:e0132494. [PMID: 26147995 PMCID: PMC4492509 DOI: 10.1371/journal.pone.0132494] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 06/15/2015] [Indexed: 11/26/2022] Open
Abstract
Background and Purpose The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not. Methods Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured) were analyzed from 3D-digital subtraction angiography (DSA) images and computational fluid dynamics (CFD). Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC) analysis identified area under the curve (AUC) and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators. Results Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type) and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity) parameters achieved statistical significance (p<0.05). Six morphologic (size, surface area, volume, aspect ratio, size ratio and regular/irregular type) and five hemodynamic (WSSmean, WSSmin, LSA, flow stability and flow complexity) parameters had high AUC values (AUC>0.7). By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883–0.965). Conclusions Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.
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12
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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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13
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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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14
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Hoh BL, Kleinhenz DT, Chi YY, Mocco J, Barker FG. Incidence of ventricular shunt placement for hydrocephalus with clipping versus coiling for ruptured and unruptured cerebral aneurysms in the Nationwide Inpatient Sample database: 2002 to 2007. World Neurosurg 2012; 76:548-54. [PMID: 22251503 DOI: 10.1016/j.wneu.2011.05.054] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 05/16/2011] [Accepted: 05/26/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND Few studies have compared the incidence of ventricular shunt placement for hydrocephalus after clipping versus coiling of cerebral aneurysms. OBJECTIVE The Nationwide Inpatient Sample (NIS) database was used to compare, on a national level, the incidence of ventricular shunt placement after clipping versus coiling of ruptured and unruptured aneurysms. METHODS Hospitalizations for clipping and coiling of ruptured and unruptured aneurysms from 2002 to 2007 were collected from the NIS by cross-matching International Classification of Diseases-9 codes for diagnoses of subarachnoid hemorrhage or unruptured cerebral aneurysm with procedure codes for clipping or coiling. The incidence of ventricular shunt placement for hydrocephalus after clipping and coiling was compared using generalized linear models with generalized estimating equations (GEE) to adjust for patient- and hospital-specific factors and correlation between admissions. RESULTS Of 10,899 ruptured aneurysm patients (6593 clipping, 4306 coiling), clipping had a similar incidence of ventricular shunt placement (9.3%) compared to coiling (10.5%) (odds ratio = 0.984; 95% confidence interval = 0.85, -1.14; P value = 0.833 after adjustment for patient-specific and hospital-specific factors). Likewise, of 9686 unruptured aneurysm patients (4483 clipping, 5203 coiling), clipping had similar incidence of ventricular shunt placement (0.4%) compared to coiling (0.5%) (odds ratio = 0.763; 95% confidence interval = 0.37, -1.58; P value = 0.465 after adjustment for patient-specific and hospital-specific factors). Predictors of shunt placement in ruptured aneurysm patients were age, comorbidity score, admission type, payer, and hospital aneurysm volume. Predictors of shunt placement in unruptured aneurysm patients were comorbidity score and admission type. CONCLUSIONS In an observational study, clipping and coiling of ruptured and unruptured cerebral aneurysms are associated with similar incidences of ventricular shunt placement for hydrocephalus.
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Affiliation(s)
- Brian L Hoh
- Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
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Unsecured Intracranial Aneurysms and Induced Hypertension in Cerebral Vasospasm: Is Induced Hypertension Safe? Neurocrit Care 2011; 14:168-75. [DOI: 10.1007/s12028-011-9510-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Wachter D, Kreitschmann-Andermahr I, Gilsbach JM, Rohde V. Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm? J Neurosurg 2010; 114:935-41. [PMID: 21166569 DOI: 10.3171/2010.10.jns10186] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT As many as 33% of patients suffering from subarachnoid hemorrhage (SAH) present with multiple intracranial aneurysms (MIAs). It is believed that aneurysm surgery has the potential to increase the risk of cerebral vasospasm due to surgical manipulations of the parent vessels and brain tissue. Consequently, 1-stage surgery of MIAs, which usually takes longer and requires more manipulation, could even further increase the risk of vasospasm. The aim of this study is to define the correlation between vasospasm and the operative treatment of single intracranial aneurysms versus MIAs in a 1-stage operation. METHODS The authors analyzed a database including 1016 patients with SAH, identified retrospectively between 1989 and 1996 and prospectively collected between 1997 and 2004. Exclusion criteria were endovascular treatment, surgery after SAH Day 3, and, in patients with MIAs, undergoing more than 1 operation. Cerebral vasospasm was diagnosed by transcranial Doppler (TCD) ultrasonography and was defined as a maximum mean blood flow velocity > 120 cm/second. The diagnosis of symptomatic vasospasm was made if a new neurological deficit occurred that could not be explained by concomitant complications. RESULTS A total of 643 patients who experienced 810 aneurysms were included. Four hundred twenty-four patients were female (65.9%) and 219 were male (34.1%) with an average age of 53.1 years. One hundred twenty-one patients (18.8%) were diagnosed with MIAs. Maximum mean flow velocities measured by TCD were 131 cm/second in patients with MIAs and 129.5 cm/second in patients with single intracranial aneurysms. The incidence of TCD vasospasm (p = 0.561) as well as of symptomatic vasospasm (p = 0.241) was not significantly different in the 2 groups. CONCLUSIONS Clipping of more than 1 aneurysm in a 1-stage operation within 72 hours after SAH can be performed without increasing the risk of cerebral (TCD) vasospasm and symptomatic vasospasm.
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Affiliation(s)
- Dorothee Wachter
- Department of Neurosurgery, Georg-August-University Göttingen, Germany.
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Lall RR, Eddleman CS, Bendok BR, Batjer HH. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data. Neurosurg Focus 2009; 26:E2. [DOI: 10.3171/2009.2.focus0921] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aneurysmal subarachnoid hemorrhage continues to have high rates of morbidity and mortality for patients despite optimal medical and surgical management. Due to the fact that aneurysmal rupture can be such a catastrophic event, preventive treatment is desirable for high-risk lesions. Given the variability of the literature evaluating unruptured aneurysms regarding basic patient population, clinical practice, and aneurysm characteristics studied, such as size, location, aspect ratio, relationship to the surrounding vasculature, and the aneurysm hemodynamics, a metaanalysis is nearly impossible to perform. This review will instead focus on the various anatomical and morphological characteristics of aneurysms reported in the literature with an attempt to draw broad inferences and serve to highlight pressing questions for the future in our continued effort to improve clinical management of unruptured intracranial aneurysms.
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