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Sturiale CL, Scerrati A, Ricciardi L, Rustemi O, Auricchio AM, Norri N, Piazza A, Raneri F, Benato A, Albanese A, Mangiola A, Zotta DC, D’Andrea G, Picotti V, Raco A, Volpin L, Trevisi G. Geometry and Symmetry of Willis' Circle and Middle Cerebral Artery Aneurysms Development. J Clin Med 2024; 13:2808. [PMID: 38792350 PMCID: PMC11122484 DOI: 10.3390/jcm13102808] [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: 02/28/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: A relationship between the geometry and symmetry of Willis' circle and intracranial aneurysms was reported for anterior communicating and posterior communicating (PCom) aneurysms. A similar association with the middle cerebral artery (MCA) aneurysms instead appeared weaker. Methods: We reviewed 432 patients from six Italian centers with unilateral MCA aneurysms, analyzing the relationship between the caliber and symmetry of Willis' circle and the presence of ruptured and unruptured presentation. CT-angiograms were evaluated to assess Willis' circle geometrical characteristics and the MCA aneurysm side, dimension and rupture status. Results: The hypoplasia of the first segment of the anterior cerebral artery (A1) was in approximately one-quarter of patients and PCom hypoplasia was in almost 40%. About 9% had a fetal PCom ipsilaterally to the aneurysm. By comparing the aneurysmal and healthy sides, only the PCom hypoplasia appeared significantly higher in the affected side. Finally, the caliber of the internal carotid artery (ICA) and the first segment of MCA (M1) caliber were significantly greater in patients with unruptured aneurysms, and PCom hypoplasia appeared related to the incidence of an ipsilateral MCA aneurysm and its risk of rupture. Conclusions: Although according to these findings asymmetries of Willis' circle are shown to be a risk factor for MCA aneurysm formation and rupture, the indifferent association with ipsilateral or contralateral hypoplasia remains a datum of difficult hemodynamic interpretation, thereby raising the concern that this association may be more casual than causal.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
| | - Alba Scerrati
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Luca Ricciardi
- Neurosurgical Unit, NESMOS Department, Sapienza University of Rome, 00161 Rome, Italy; (L.R.); (A.P.)
| | - Oriela Rustemi
- Department of Neurosurgery, San Bortolo Hospital, 36100 Vicenza, Italy; (O.R.); (F.R.)
| | - Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
- Department of Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nicolò Norri
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Amedeo Piazza
- Neurosurgical Unit, NESMOS Department, Sapienza University of Rome, 00161 Rome, Italy; (L.R.); (A.P.)
| | - Fabio Raneri
- Department of Neurosurgery, San Bortolo Hospital, 36100 Vicenza, Italy; (O.R.); (F.R.)
| | - Alberto Benato
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
| | - Annunziato Mangiola
- Department of Neurosciences, Imaging and Clinical Sciences, G. D’Annunzio University, 66100 Chieti, Italy
| | | | - Giancarlo D’Andrea
- Neurosurgical Unit, Spaziani Hospital, 03100 Frosinone, Italy; (G.D.); (V.P.)
| | - Veronica Picotti
- Neurosurgical Unit, Spaziani Hospital, 03100 Frosinone, Italy; (G.D.); (V.P.)
| | - Antonino Raco
- Neurosurgical Unit, NESMOS Department, Sapienza University of Rome, 00161 Rome, Italy; (L.R.); (A.P.)
| | - Lorenzo Volpin
- Department of Neurosurgery, San Bortolo Hospital, 36100 Vicenza, Italy; (O.R.); (F.R.)
| | - Gianluca Trevisi
- Department of Neurosciences, Imaging and Clinical Sciences, G. D’Annunzio University, 66100 Chieti, Italy
- Neurosurgical Unit, Ospedale Spirito Santo, 65122 Pescara, Italy
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Arrambide-Garza FJ, Alvarez-Lozada LA, de León-Gutiérrez H, Villarreal-Silva EE, Alvarez-Villalobos NA, Quiroga-Garza A, Elizondo-Omaña RE, Guzman-Lopez S. Fetal-type posterior cerebral artery and association of rupture in posterior communicating artery aneurysms: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 231:107815. [PMID: 37301004 DOI: 10.1016/j.clineuro.2023.107815] [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: 03/07/2023] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The morbidity and mortality of intracranial aneurysm rupture motivate the risk evaluation of the patient´s characteristics and aneurysm's morphology. Brain vessel variants lead to hemodynamic changes that could increase risk. This study aims to evaluate the fetal posterior cerebral artery (fPCA) as a risk factor for the formation, rupture, and recurrence of the posterior communicating artery (PComA) aneurysm. METHODS A search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE databases for studies that evaluated the risk of appearance, rupture, and recurrence of PComA aneurysms with the presence of fPCA. Newcastle-Ottawa Scale and AXIS were used for quality assessment. The primary and secondary outcomes were evaluated and interpreted with an odds ratio (OR) and their 95% confidence intervals (CI). RESULTS A total of 577 articles were reviewed. Thirteen studies were included for the qualitative analysis, and ten studies for the meta-analysis. All cohort studies were classified as poor quality, and all cross-sectional studies with moderate risk. The unadjusted OR resulted in 1.57 (n = 6, 95% CI 1.13-2.19, p = <0.001, I2 =0%) between the presence of fPCA and PComA aneurysm rupture. CONCLUSION There is a significant association of aneurysm formation and rupture of PComA aneurysms in the presence of fPCA. This may be triggered by the hemodynamic alterations caused by the variation, leading to changes in the vessel wall.
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Affiliation(s)
| | | | - Humberto de León-Gutiérrez
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, KER Unit, México, Mexico.
| | | | - Neri Alejandro Alvarez-Villalobos
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, KER Unit, México, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, United States.
| | - Alejandro Quiroga-Garza
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico; Instituto Mexicano del Seguro Social, Delegación Nuevo Leon, Monterrey, Mexico.
| | | | - Santos Guzman-Lopez
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico.
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Kawada T. Letter to the Editor Regarding "Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries". World Neurosurg 2022; 161:208. [PMID: 35505527 DOI: 10.1016/j.wneu.2022.01.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-ku, Japan.
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Chebaro K, Oberman DZ, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. Letter to the Editor Regarding "Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries". World Neurosurg 2022; 161:214. [PMID: 35505531 DOI: 10.1016/j.wneu.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Kamel Chebaro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | | | | | | | - Cristina Elizondo
- Department of Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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