1
|
Johnson MD, Palmisciano P, Yamani AS, Hoz SS, Prestigiacomo CJ. A Systematic Review and Meta-Analysis of 3-Dimensional Morphometric Parameters for Cerebral Aneurysms. World Neurosurg 2024; 183:214-226.e5. [PMID: 38160907 DOI: 10.1016/j.wneu.2023.12.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Imaging modalities with increased spatial resolution have allowed for more precise quantification of cerebral aneurysm shape in 3-dimensional (3D) space. We conducted a systematic review and meta-analysis to assess the correlation of individual 3D morphometric measures with cerebral aneurysm rupture status. METHODS Two independent reviewers performed a PRISMA (preferred reporting items of systematic reviews and meta-analysis)-guided literature search to identify articles reporting the association between 3D morphometric measures of intracranial aneurysms and rupture status. RESULTS A total of 15,122 articles were identified. After screening, 39 studies were included. We identified 17 3D morphometric measures, with 11 eligible for the meta-analysis. The meta-analysis showed a significant association with rupture status for the following measures: nonsphericity index (standardized mean difference [SMD], 0.66; 95% confidence interval [CI], 0.53-0.79; P < 0.0001; I2 = 55.2%), undulation index (SMD, 0.55; 95% CI, 0.26-0.85; P = 0.0017; I2 = 68.1%), ellipticity index (SMD, 0.53; 95% CI, 0.29-0.77; P = 0.0005; I2 = 70.8%), volume (SMD, 0.18; 95% CI, 0.02-0.35; P = 0.0320; I2 = 82.3%), volume/ostium ratio (SMD, 0.43; 95% CI, 0.16-0.71; P = 0.0075; I2 = 90.4%), elongation (SMD, -0.94; 95% CI, -1.12 to -0.76; P = 0.0005; I2 = 0%), flatness (SMD, -0.87; 95% CI, -1.04 to -0.71; P = 0.0005; I2 = 0%), and sphericity (SMD, -0.62; 95% CI, -1.06 to -0.17; P = 0.0215; I2 = 67.9%). A significant risk of publication bias was estimated for the ellipticity index (P = 0.0360) and volume (P = 0.0030). CONCLUSIONS Based on the results of a meta-analysis containing 39 studies, the nonsphericity index, undulation index, elongation, flatness, and sphericity demonstrated the most consistent correlation with rupture status.
Collapse
Affiliation(s)
- Mark D Johnson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
| | - Paolo Palmisciano
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ali S Yamani
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer S Hoz
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
2
|
Tsantili AR, Karampelias V, Samolis A, Chrysikos D, Antonopoulos I, Spanidis Y, Protogerou V, Troupis T. Anatomical variations of human vertebral and basilar arteries: A current review of the literature. Morphologie 2022; 107:169-175. [PMID: 35907771 DOI: 10.1016/j.morpho.2022.07.001] [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: 05/11/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
The vertebral artery originates from the subclavian artery and is divided into four segments (V1-V4). In its intracranial segment (V4), the two vertebral arteries join to form the basilar artery, an unpaired medium-sized artery. However, apart from this typical description, several anatomical variations may occur in the human body. Although in some cases such variations may be asymptomatic, they may be also associated with several pathological conditions, neurological complications, surgical complications, and increased risk of developing vascular diseases. Therefore, it is crucial to obtain sufficient information on the anatomy and variants of both arteries to prevent such complications and ensure the safe completion of surgical and radiological treatments. For this reason, we reviewed studies published up to January 2022 concerning the reported variations of the vertebral artery and basilar artery regarding their origin, course, length, and diameter. We believe that the thorough presentation of these variations would help surgeons worldwide during their daily clinical and surgical practice.
Collapse
Affiliation(s)
- A R Tsantili
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - V Karampelias
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; School of Medicine, University of Patras, Patras, Greece
| | - A Samolis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Antonopoulos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Y Spanidis
- School of Medicine, University of Patras, Patras, Greece
| | - V Protogerou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - T Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
3
|
Muhammad S, Rezai Jahromi B, Kaukovalta H, Schwartz C, Hijazy F, Goehre F, Kozyrev DA, Kivisaari R, Hänggi D, Niemelä M. Anatomic Risk Factors for S1 Segment Superior Cerebellar Artery Aneurysm Rupture: A Radiologic Study on 81 Consecutive Patients. World Neurosurg 2021; 158:e344-e351. [PMID: 34740829 DOI: 10.1016/j.wneu.2021.10.177] [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: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Due to treatment associated risks, it is still debatable which unruptured aneurysm should be treated. Anatomic and morphologic characteristics may aid to predict the rupture risk of superior cerebellar artery (SCA) aneurysm and possibly support in decision- making during treatment. OBJECTIVES To identify morphologic characteristics that could predict the rupture of SCA aneurysms. METHODS A retrospective analysis of computed tomography angiography images of 81 consecutive patients harboring SCA aneurysm who were treated between 1980 to 2014 at Helsinki University Hospital was performed. RESULTS Of the 81 analyzed SCA aneurysms, 30 (37%) were unruptured and remaining 51 (63%) presented with subarachnoid hemorrhage. The mean ± SD size of unruptured SCA aneurysms was 6.2 ± 6.3 mm; mean size of ruptured SCA aneurysms was 5.9 ± 5.4 mm. The mean ± SD aspect ratio was 0.9 ± 0.3 in unruptured and 1.14 ± 0.44 in ruptured SCA aneurysms. The mean ± SD degree angle between basilar artery and aneurysm was 74.7 ± 24.4 in unruptured and 65.9 ± 23 ruptured SCA aneurysms. Patients with ruptured SCA aneurysm showed significantly higher aspect ratio (Mann-Whitney U, P = 0.01) and smaller aneurysm to basilar artery angle (Mann-Whitney U, P = 0.039). Aspect ratio >1.1 had 2.3 times higher risk of rupture (odds ration [OR] 2.3, 95% confidence interval [CI] 0.84-6.34). An aneurysm to basilar angle <70 degrees had 2.8 times higher risk of rupture (OR 2.75, 95% CI 1.086-6.96). CONCLUSIONS Ruptured SCA aneurysms are usually small in size. Higher aspect ratio and smaller angle between SCA aneurysm and basilar artery had significantly higher risk of SCA (S1 segment) aneurysm rupture.
Collapse
Affiliation(s)
- Sajjad Muhammad
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Kaukovalta
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ferzat Hijazy
- Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany
| | - Felix Goehre
- Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany
| | - Danil A Kozyrev
- Department of Paediatric Neurology and Neurosurgery, Northwestern State Medical University, St. Petersburg, Russia
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
4
|
Chung J, Ko JH. An Efficient Method for Aneurysm Volume Quantification Applicable in Any Shape and Modalities. J Korean Neurosurg Soc 2021; 64:514-523. [PMID: 34185985 PMCID: PMC8273770 DOI: 10.3340/jkns.2020.0255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Aneurysm volume quantification (AVQ) using the equation of ellipsoid volume is widely used although it is inaccurate. Furthermore, AVQ with 3-dimensional (3D) rendered data has limitations in general use. A novel universal method for AVQ is introduced for any diagnostic modality and application to any shape of aneurysms.
Methods Relevant AVQ studies published from January 1997 to June 2019 were identified to determine common methods of AVQ. The basic idea is to eliminate the normal artery volume from 3D model with the aneurysm. After Digital Imaging and Communications in Medicine (DICOM) data is converted and exported to stereolithography (STL) file format, the 3D STL model is modified to remove the aneurysm and the volume difference between the 3D model with/without the aneurysm is defined as the aneurysm volume. Fifty randomly selected aneurysms from DICOM database were used to validate the different AVQ methods.
Results We reviewed and categorized AVQ methods in 121 studies. Approximately 60% used the ellipsoid method, while 24% used the 3D model. For 50 randomly selected aneurysms, volumes were measured using 3D Slicer, RadiAnt, and ellipsoid method. Using 3D Slicer as the reference, the ratios of mean difference to mean volume obtained by RadiAnt and ellipsoid method were -1.21±7.46% and 4.04±30.54%, respectively. The deviations between RadiAnt and 3D Slicer were small despite of aneurysm shapes, but those of ellipsoid method and 3D Slicer were large.
Conclusion In spite of inaccuracy, ellipsoid method is still mostly used. We propose a novel universal method for AVQ that is valid, low cost, and easy to use.
Collapse
Affiliation(s)
- Jaewoo Chung
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Ho Ko
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
5
|
Li L, Hofmann BB, Fischer I, Donaldson DM, Engel A, Karadag C, Wetzel-Yalelis A, Piedade GS, Mijderwijk HJ, Bostelmann R, Kaschner MG, Muhammad S, Hänggi D, Cornelius JF, Petridis AK. Asymmetry of P1 and vertebral arteries is not related to basilar tip aneurysm development or rupture. Acta Neurochir (Wien) 2021; 163:805-812. [PMID: 33025090 PMCID: PMC7886757 DOI: 10.1007/s00701-020-04593-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Lately, morphological parameters of the surrounding vasculature aside from aneurysm size, specific for the aneurysm location, e.g., posterior cerebral artery angle for basilar artery tip aneurysms, could be identified to correlate with the risk of rupture. We examined further image-based morphological parameters of the aneurysm surrounding vasculature that could correlate with the growth or the risk of rupture of basilar artery tip aneurysms. METHODS Data from 83 patients with basilar tip aneurysms (27 not ruptured; 56 ruptured) and 100 control patients were assessed (50 without aneurysms and 50 with aneurysms of the anterior circle of Willis). Anatomical parameters of the aneurysms were assessed and analyzed, as well as of the surrounding vasculature, namely the asymmetry of P1 and the vertebral arteries. RESULTS Patients with basilar tip aneurysm showed no significant increase in P1 or vertebral artery asymmetry compared with the control patients or patients with aneurysms of the anterior circulation, neither was there a significant difference in asymmetry between cases with ruptured and unruptured aneurysms. Furthermore, we observed no significant correlations between P1 asymmetry and the aneurysm size or number of lobuli in the aneurysms. CONCLUSION We observed no significant difference in aneurysm size, rupture, or lobulation associated with P1 or vertebral artery (surrounding vasculature) asymmetry. Therefore, the asymmetry of the surrounding vessels does not seem to be a promising morphological parameter for the evaluation of probability of rupture and growth in basilar tip aneurysms in future studies.
Collapse
|
6
|
徐 旭, 张 金, 彭 婉, 刘 科, 胡 斯, 曾 令, 夏 春, 李 真. [Application of 3.0T Time-of-flight Magnetic Resonance Angiography with Sparse Undersampling and Iterative Reconstruction in the Diagnosis of Unruptured Intracranial Aneurysms]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2021; 52:92-97. [PMID: 33474896 PMCID: PMC10408958 DOI: 10.12182/20210160602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of 3.0T time-of-flight MR angiography with sparse undersampling and iterative reconstruction (TOFu-MRA) for unruptured intracranial aneurysms (UIAs) on the basis of using digital subtraction angiography (DSA) as the reference standard. METHODS A total of 65 patients with suspected UIAs were prospectively enrolled and all patients underwent TOFu-MRA and DSA. Relying on DSA as the reference standard, the sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) of using TOFu-MRA in UIA diagnosis were calculated, and the inter-observer agreement between two doctors was determined. Comparison of maximum intensity projection (MIP) and volume rendering (VR) image datasets was made to evaluate the agreement between DSA results and TOFu-MRA in the measurement of UIA morphological parameters, including the neck width (D neck), height (H) , and width (D width) of UIAs. RESULTS The study covered 55 UIAs from 46 patients. The SEN, SPE, PPV and NPV of the two doctors using TOFu-MRA in UIA diagnosis were as follows: (95.7%, 95.7%), (94.7%, 94.7%), (97.8%, 97.8%) and (90.0%, 90.0%), respectively for patient-based assessment; (96.4%, 94.5%), (94.7%, 94.7%), (98.1%, 98.1%) and (90.0%, 85.7%), respectively, for aneurysm-based assessment. There is a strong inter-observer agreement (Kappa=0.93 for patient-based assessment and 0.96 for aneurysm-based assessment) between the two doctors. Moreover, Bland-Altman analysis showed that more than 95% points fell within the limits of agreement (LoA), suggesting strong agreement between the two examination methods for the measurement of UIAs morphological parameters. CONCLUSION TOFu-MRA showed good diagnostic efficacy for UIAs and the results were in good agreement with those of DSA, the reference standard, for assessing UIA morphological parameter. TOFu-MRA can be used as a first choice for noninvasive diagnostic evaluation of UIAs.
Collapse
Affiliation(s)
- 旭 徐
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 金戈 张
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婉琳 彭
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 科伶 刘
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 斯娴 胡
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 令明 曾
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 春潮 夏
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 真林 李
- 四川大学华西医院 放射科 ( 成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
7
|
Age and morphology of posterior communicating artery aneurysms. Sci Rep 2020; 10:11545. [PMID: 32665589 PMCID: PMC7360743 DOI: 10.1038/s41598-020-68276-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
Risk of intracranial aneurysm rupture could be affected by geometric features of intracranial aneurysms and the surrounding vasculature in a location specific manner. Our goal is to investigate the morphological characteristics associated with ruptured posterior communicating artery (PCoA) aneurysms, as well as patient factors associated with the morphological parameters.
Three-dimensional morphological parameters in 409 patients with 432 PCoA aneurysms diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016 who had available CT angiography (CTA) or digital subtraction angiography (DSA) were evaluated. Morphological parameters examined included aneurysm wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal PCoA, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological parameters with rupture of PCoA aneurysms. Additional analyses were performed to determine the association of patient factors with the morphological parameters. Irregular, multilobed PCoA aneurysms with larger height/width ratios and larger flow angles were associated with ruptured PCoA aneurysms, whereas perpendicular height was inversely associated with rupture in a multivariable model. Older age was associated with lower aspect ratio, with a trend towards lower height/width ratio and smaller flow angle, features that are associated with a lower rupture risk. Morphological parameters are easy to assess and could help in risk stratification in patients with unruptured PCoA aneurysms. PCoA aneurysms diagnosed at older age have morphological features associated with lower risk.
Collapse
|
8
|
Stapleton CJ, Theiss P, Arnone GD, Shakur SF, Charbel FT. Occlusion of Extracranial-Intracranial Bypass Anastomosis-Associated Aneurysms Following Contralateral High-Flow Extracranial-Intracranial Bypass in a Patient with Impaired Cerebrovascular Reserve. Oper Neurosurg (Hagerstown) 2020; 18:E243-E247. [PMID: 31504843 DOI: 10.1093/ons/opz249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Extracranial-intracranial (EC-IC) bypass anastomosis-associated aneurysms are rare sequelae of cerebral revascularization surgery. Although treatment paradigms are not well defined, clipping, trapping with revision bypass, and donor vessel ligation represent the most common microsurgical approaches. CLINICAL PRESENTATION A 53-yr-old male presented with cognitive decline, left extremity weakness, and left visual field blurriness. Computed tomographic angiography of head/neck demonstrated bilateral cervical internal carotid artery occlusion and magnetic resonance imaging of brain showed a small right parieto-occipital lobe infarct. The patient's symptoms worsened despite aggressive medical management. Therefore, a right superficial temporal artery to middle cerebral artery (STA-MCA) bypass was performed for flow augmentation. Follow-up digital subtraction angiography (DSA) approximately 1 yr after surgery noted 2 new aneurysms adjacent to the patent STA-MCA anastomosis. Perfusion imaging at that time showed persistently reduced blood flow in the left cerebral hemisphere. A left STA-MCA bypass was performed, and intraoperative blood flow measurements showed this to be a high-flow bypass. Follow-up DSA 4 mo later demonstrated involution of the right STA-MCA bypass and occlusion of the anastomosis-associated aneurysms with increased perfusion of the right cerebral hemisphere via collateral blood flow from the patent high-flow left STA-MCA bypass. At 7 mo following left STA-MCA bypass, the patient's neurological examination remained stable and perfusion imaging showed improved blood flow in the left cerebral hemisphere. CONCLUSION We present a unique case in which a high-flow left EC-IC bypass with robust contralateral collateral blood flow was associated with subsequent occlusion of a right EC-IC bypass and 2 anastomosis-associated aneurysms in a patient with bilateral impaired cerebrovascular reserve.
Collapse
Affiliation(s)
| | - Peter Theiss
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Gregory D Arnone
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Sophia F Shakur
- Peninsula Regional Neurosurgery, Peninsula Regional Medical Center, Salisbury, Maryland
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
9
|
Zhang J, Can A, Mukundan S, Steigner M, Castro VM, Dligach D, Finan S, Yu S, Gainer V, Shadick NA, Savova G, Murphy S, Cai T, Wang Z, Weiss ST, Du R. Morphological Variables Associated With Ruptured Middle Cerebral Artery Aneurysms. Neurosurgery 2020; 85:75-83. [PMID: 29850834 DOI: 10.1093/neuros/nyy213] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/27/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce. OBJECTIVE To investigate the morphological characteristics associated with ruptured middle cerebral artery (MCA) aneurysms. METHODS Five hundred sixty-one patients with 638 MCA aneurysms diagnosed between 1990 and 2016 who had available computed tomography angiography (CTA) were included in this study. CTAs were evaluated using the Vitrea Advanced Visualization software for 3-dimensional (3D) reconstruction. Morphological parameters examined in each model included aneurysm projection, wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal posterior communicating arteries (PCoA), aneurysm height and width, neck diameter, bottleneck factor, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological characteristics with rupture of MCA aneurysms. Logistic regression was used to build a predictive MCA score. RESULTS Greater bottleneck and size ratio, and irregular, multilobed, temporally projecting MCA aneurysms are associated with higher rupture risk, whereas higher M1/M2 ratio, larger width, and the presence of an ipsilateral or bilateral hypoplastic PCoA were inversely associated with rupture. The MCA score had good predictive capacity with area under the receiver operating curve = 0.88. CONCLUSION These practical morphological parameters specific to MCA aneurysms are easy to assess when examining 3D reconstructions of unruptured aneurysms and could aid in risk evaluation in these patients.
Collapse
Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Steigner
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victor M Castro
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University, Chicago, Illinois
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, Massachusetts
| | - Sheng Yu
- Center for Statistical Science, Tsinghua University, Beijing, China
| | - Vivian Gainer
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, Massachusetts
| | - Shawn Murphy
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tianxi Cai
- Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
10
|
Rosenbaum MD, Heiferman DM, Raslan OA, Martin B, Dominguez JF, de la Peña PM, Ashley WW, Rosenblum JD, Germanwala AV. Basilar Apex Aneurysms in the Setting of Carotid Artery Stenosis: Case Series and Angiographic Anatomic Study. Curr Neurovasc Res 2019; 16:12-18. [DOI: 10.2174/1567202616666190129150403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/22/2022]
Abstract
Background:
Intracranial aneurysms (IAs) are life-threatening lesions known within the
literature to be found incidentally during routine angiographic workup for carotid artery stenosis
(CAS). As IAs are associated with vascular shear stress, it is reasonable to expect that altered flow
demands within the anterior circulation, such as with CAS, increase compensatory flow demands
via the Circle of Willis (COW) and may induce similar stress at the basilar apex.
Objective:
We present a series of nine unruptured basilar apex aneurysms (BAA) with CAS and a
comparative radiographic analysis to BAA without CAS.
Methods:
Twenty-three patients with BAA were retrospectively identified using records from
2011 to 2016. CAS by North American Symptomatic Carotid Endarterectomy Trial (NASCET)
criteria, morphology of BAA, competency of COW, and anatomic relationships within the posterior
circulation were examined independently by a neuroradiologist using angiographic imaging.
Results:
Nine (39%) of the twenty-three BAA patients had CAS, with six having stenosis ≥50%.
Four (67%) of the patients with ≥50% CAS demonstrated aneurysm flow angles contralateral to
the side with highest CAS. Additionally, the angle between the basilar artery (BA) trajectory and
aneurysm neck was observed to be smaller in patients with ≥50% CAS (61 vs 74 degrees). No significant
differences in COW patency, posterior circulation morphology, and degree of stenosis
were observed.
Conclusion:
Changes in the cervical carotid arteries may lead to blood flow alterations in the posterior
circulation that increase the propensity for BAA formation. Posterior circulation imaging can
be considered in CAS patients to screen for BAA.
Collapse
Affiliation(s)
- Mihael D. Rosenbaum
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, United States
| | - Daniel M. Heiferman
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, United States
| | - Osama A. Raslan
- Department of Radiology, University of California- Davis Medical Center, Sacramento, CA, United States
| | - Brendan Martin
- Department of Research, National Council of State Boards of Nursing, Chicago, IL, United States
| | - Jose F. Dominguez
- Department of Neurological Surgery, New York Medical College, Valhalla, NY, United States
| | - Paula M. de la Peña
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, United States
| | - William W. Ashley
- Department of Neurosurgery, The Sandra and Malcolm Berman Brain and Spine Institute, Sinai Hospital and LifeBridge Health System, Baltimore, MD, United States
| | - Jordan D. Rosenblum
- Department of Radiology, Loyola University Stritch School of Medicine, Maywood, IL, United States
| | - Anand V. Germanwala
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, United States
| |
Collapse
|
11
|
Abecassis IJ, Sen RD, Barber J, Shetty R, Kelly CM, Ghodke BV, Hallam DK, Levitt MR, Kim LJ, Sekhar LN. Predictors of Recurrence, Progression, and Retreatment in Basilar Tip Aneurysms: A Location-Controlled Analysis. Oper Neurosurg (Hagerstown) 2019; 16:435-444. [PMID: 29905850 DOI: 10.1093/ons/opy132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/29/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Endovascular treatment of intracranial aneurysms is associated with higher rates of recurrence and retreatment, though contemporary rates and risk factors for basilar tip aneurysms (BTAs) are less well-described. OBJECTIVE To characterize progression, retreatement, and retreated progression of BTAs treated with microsurgical or endovascular interventions. METHODS We retrospectively reviewed records for 141 consecutive BTA patients. We included 158 anterior communicating artery (ACoA) and 118 middle cerebral artery (MCA) aneurysms as controls. Univariate and multivariate analyses were used to calculate rates of progression (recurrence of previously obliterated aneurysms and progression of known residual aneurysm dome or neck), retreatment, and retreated progression. Kaplan-Meier analysis was used to characterize 24-mo event rates for primary outcome prediction. RESULTS Of 141 BTA patients, 62.4% were ruptured and 37.6% were unruptured. Average radiographical follow-up was 33 mo. Among ruptured aneurysms treated with clipping, there were 2 rehemorrhages due to recurrence (6.1%), and none in any other cohorts. Overall rates of progression (28.9%), retreatment (28.9%), and retreated progression (24.7%) were not significantly different between surgical and endovascular subgroups, though ruptured aneurysms had higher event rates. Multivariate modeling confirmed rupture status (P = .003, hazard ratio = 0.14) and aneurysm dome width (P = .005, hazard ratio = 1.23) as independent predictors of progression requiring retreatment. In a separate multivariate analysis with ACoA and MCA aneurysms, basilar tip location was an independent predictor of progression, retreatment, and retreated progression. CONCLUSION BTAs have higher rates of progression and retreated progression than other aneurysm locations, independent of treatment modality. Rupture status and dome width are risk factors for progression requiring retreatment.
Collapse
Affiliation(s)
- Isaac Josh Abecassis
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Rajeev D Sen
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Rakshith Shetty
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Cory M Kelly
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | | | - Danial K Hallam
- Department of Radiology, University of Washington, Seattle, Washington
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle, Washington.,Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle, Washington
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| |
Collapse
|
12
|
Song J, Zhu F, Qian Y, Ou C, Cai J, Zou X, Wu Z, Zhu W, Chen L, Mao Y. Morphological and Hemodynamic Differences Between Aneurysmal Middle Cerebral Artery Bifurcation and Contralateral Nonaneurysmal Anatomy. Neurosurgery 2018; 81:779-786. [PMID: 28379506 DOI: 10.1093/neuros/nyx093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/10/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The morphological and hemodynamic features differ between middle cerebral artery (MCA) bifurcations with and without aneurysms. OBJECTIVE To investigate the morphological and hemodynamic differences between aneurysmal MCA bifurcation and contralateral nonaneurysmal anatomy. METHODS Computed tomography angiography of 36 patients with unilateral small saccular MCA bifurcation aneurysms was evaluated. The parent-daughter angles (φ1 for larger branch and φ2 for smaller branch), bifurcation angle (φ = φ1 + φ2), inclination angle (γ angle), and their relationships with the MCA bifurcation locations were analyzed. Computational fluid dynamics simulation was performed in 6 cases to explore the hemodynamics influenced by the bifurcation morphology. RESULTS The φ angle was significantly higher in aneurysmal than contralateral nonaneurysmal bifurcations (160.8° ± 31.0° vs 99.0° ± 19.2°, respectively; P = .000); the φ1, φ2, and γ angles were also higher. However, by regression analysis combined with MCA bifurcation locations, only the φ angle might be associated with the aneurysm presence (odds ratio = 1.120, 95% confidence interval = 1.059-1.185) and a φ angle cut-off of 124.8° was established. Computational fluid dynamics simulation demonstrated that flow resistance of the wider aneurysmal MCA bifurcation was significantly higher than that on the contralateral side. CONCLUSION A larger φ angle was more prevalent in aneurysmal than nonaneurysmal MCA bifurcations, and the higher flow resistance caused by the larger φ angle might be a potential hemodynamic factor associated with MCA aneurysm presence.
Collapse
Affiliation(s)
- Jianping Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Fengping Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Yi Qian
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Chubin Ou
- Department of Mechanical and Aerospace Engineering, Hong Kong University of Science and Technology, Hong Kong, China
| | - Jiajun Cai
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zehan Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
13
|
Risk factor analysis of recanalization and retreatment for patients with endovascular treatment of internal carotid artery bifurcation aneurysms. Neuroradiology 2018; 60:535-544. [PMID: 29572603 DOI: 10.1007/s00234-018-2013-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/13/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Only a few reports of internal carotid artery (ICA) bifurcation aneurysms using the endovascular technique have been published in the current literature. The purpose of this study was to assess how multiple risk factors including angioarchitectural features of ICA bifurcation characteristics may have influenced aneurysmal rupture, recanalization, and retreatment. METHODS Fifty-one patients with 52 ICA bifurcation aneurysms treated with endovascular coiling between July 2003 and July 2015 were retrospectively analyzed. The patients' clinical records, endovascular reports, and clinical and angiographic outcomes were reviewed. We also evaluated risk factors for recanalization and retreatment, including the angioarchitectural anatomy. RESULTS The clinical outcomes were observed to be satisfactory in 49 patients (96.0%) and unfavorable in 2 patients (4.0%). The risk factor for aneurysmal rupture was young age (P = 0.024). Symptomatic complications due to thromboembolism occurred in 1.9% of cases; no patients suffered a fatal complication. Eleven of 52 ICA bifurcation aneurysms (21.2%) were recanalized within an average of 54.3 ± 33.5 months of follow-up. Among the aneurysms, 4 (7.7%) underwent recoiling. Multivariate analysis showed that ruptured aneurysms (P = 0.006) and a lower packing density (P = 0.048) were risk factors for recanalization. A lower packing density was the only risk factor for retreatment (P = 0.019). CONCLUSION Endovascular treatment of ICA bifurcation aneurysms is considered safe and acceptable. This study showed that the ICA bifurcation aneurysms ruptured more frequently at a younger age. A higher packing density has been shown to reduce major recanalization and retreatment.
Collapse
|
14
|
Yasugi M, Hossain B, Nii M, Kobashi S. Relationship Between Cerebral Aneurysm Development and Cerebral Artery Shape. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2018. [DOI: 10.20965/jaciii.2018.p0249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lifestyle and genetics are known to be the major factors causing cerebral aneurysms, but some studies suggest that the shape of cerebral arteries might be correlated with the risk of aneurysm occurrence. This study focuses on the shape of cerebral arteries where cerebral aneurysms tend to occur. First, it extracts the shape feature of the cerebral artery ring, which is a predilection site of cerebral aneurysm, from 3-D magnetic resonance angiography images, and calculates four types of shape feature vectors – 3-D shape, bifurcation angle, degree of meandering, and direction of the branch points. Then, it estimates the risk of cerebral aneurysms occurring, based on the extracted features using support vector machine. To validate the proposed method, we conducted a leave-one-out cross validation test using 80 subjects (40 subjects with and 40 subjects without cerebral aneurysms). The method using a 3-D artery shape achieved 75% sensitivity and 75% specificity; the one using the bifurcation angle showed 47% sensitivity and 41% specificity. The method using the degree of meandering showed 55% sensitivity and 53% specificity, and the one that used the direction of the six branch points showed 30% sensitivity and 27% specificity. These results show that the 3-D artery shape could be a possible indicator for predicting the risk of developing cerebral aneurysms.
Collapse
|
15
|
Rashad S, Sugiyama SI, Niizuma K, Sato K, Endo H, Omodaka S, Matsumoto Y, Fujimura M, Tominaga T. Impact of bifurcation angle and inflow coefficient on the rupture risk of bifurcation type basilar artery tip aneurysms. J Neurosurg 2018; 128:723-730. [DOI: 10.3171/2016.10.jns161695] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVERisk factors for aneurysm rupture have been extensively studied, with several factors showing significant correlations with rupture status. Several studies have shown that aneurysm shape and hemodynamics change after rupture. In the present study the authors investigated a static factor, the bifurcation angle, which does not change after rupture, to understand its effect on aneurysm rupture risk and hemodynamics.METHODSA hospital database was retrospectively reviewed to identify patients with cerebral aneurysms treated surgically or endovascularly in the period between 2008 and 2015. After acquiring 3D rotational angiographic data, 3D stereolithography models were created and computational fluid dynamic analysis was performed using commercially available software. Patient data (age and sex), morphometric factors (aneurysm volume and maximum height, aspect ratio, bifurcation angle, bottleneck ratio, and neck/parent artery ratio), and hemodynamic factors (inflow coefficient and wall shear stress) were statistically compared between ruptured and unruptured groups.RESULTSSeventy-one basilar tip aneurysms were included in this study, 22 ruptured and 49 unruptured. Univariate analysis showed aspect ratio, bifurcation angle, bottleneck ratio, and inflow coefficient were significantly correlated with a ruptured status. Logistic regression analysis showed that aspect ratio and bifurcation angle were significant predictors of a ruptured status. Bifurcation angle was inversely correlated with inflow coefficient (p < 0.0005), which in turn correlated directly with mean (p = 0.028) and maximum (p = 0.014) wall shear stress (WSS) using Pearson's correlation coefficient, whereas aspect ratio was inversely correlated with mean (0.012) and minimum (p = 0.018) WSS.CONCLUSIONSBifurcation angle and aspect ratio are independent predictors for aneurysm rupture. Bifurcation angle, which does not change after rupture, is correlated with hemodynamic factors including inflow coefficient and WSS, as well as rupture status. Aneurysms with the hands-up bifurcation configuration are more prone to rupture than aneurysms with other bifurcation configurations.
Collapse
Affiliation(s)
- Sherif Rashad
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
| | | | - Kuniyasu Niizuma
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
| | | | | | | | | | - Miki Fujimura
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
| | - Teiji Tominaga
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
| |
Collapse
|
16
|
The effect of anterior projection of aneurysm dome on the rupture of anterior communicating artery aneurysms compared with posterior projection. Clin Neurol Neurosurg 2016; 143:99-103. [DOI: 10.1016/j.clineuro.2016.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
|
17
|
Stapleton CJ, Kumar JI, Walcott BP, Torok CM, Agarwalla PK, Koch MJ, Patel AB. The effect of basilar artery bifurcation angle on rates of initial occlusion, recanalization, and retreatment of basilar artery apex aneurysms following coil embolization. Interv Neuroradiol 2016; 22:389-95. [PMID: 26922975 DOI: 10.1177/1591019916633243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/25/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Arterial bifurcations are common locations for aneurysm development given the altered hemodynamic forces and shear stress variations present at these locations. Recent reports indicate that a wide basilar artery bifurcation angle is an independent predictor of aneurysm development, growth, and subsequent rupture. METHODS To determine the effect of basilar artery bifurcation angle on rates of initial occlusion, recanalization, and retreatment of basilar artery apex aneurysms following coil embolization, the records of 46 patients with basilar artery apex aneurysms treated with endovascular coil embolization from 2007 to 2013 were analyzed. RESULTS A wide basilar artery bifurcation angle was associated with a Raymond-Roy Occlusion Classification (RROC) III occlusion in univariate analysis, but was not a statistically significant factor in multivariate modeling. An increasing basilar artery bifurcation angle was not associated with aneurysm recanalization or retreatment following coil embolization. Increasing packing density (p < .01) was the only statistically significant predictor of a RROC I or II closure. The initial RROC designation was the most powerful predictor of both eventual aneurysm recanalization (p = .01) and retreatment (p = .02). While increasing aneurysm size (p < .01), increasing aneurysm volume (p < .01), and increasing neck size (p < .01) were associated with wide basilar artery bifurcation angles, neck size (p = .03) was the only statistically significant predictor of basilar artery bifurcation angle on multivariate analyses. CONCLUSION Basilar artery bifurcation angle fails to predict rates of initial occlusion, recanalization, and retreatment on multivariate modeling in our series. Basilar artery apex aneurysm neck size independently correlates with basilar artery bifurcation angle.
Collapse
Affiliation(s)
- Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Jay I Kumar
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Brian P Walcott
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Collin M Torok
- Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Pankaj K Agarwalla
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Matthew J Koch
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
18
|
Ho AL, Lin N, Frerichs KU, Du R. Smoking and Intracranial Aneurysm Morphology. Neurosurgery 2016; 77:59-66; discussion 66. [PMID: 25839377 DOI: 10.1227/neu.0000000000000735] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Smoking is a well-known independent risk factor for both aneurysm formation and rupture. There is mounting evidence that aneurysm morphology beyond size can have a significant role in aneurysm formation and rupture risk by its effects on aneurysmal hemodynamics. OBJECTIVE To study the variation in aneurysm morphology between smokers and nonsmokers and delineate how changes in these factors might affect aneurysm formation and rupture. METHODS We generated 3-dimensional models of aneurysms and their surrounding vasculature by analyzing preoperative computed tomography angiograms with Slicer software. We then examined the association between smoking status and intrinsic, transitional, and extrinsic aspects of aneurysm morphology in both univariate and multivariate statistical analyses. RESULTS From 2005 to 2013, 199 cerebral aneurysms in never smokers and current smokers were evaluated/treated at a single institution with available computed tomography angiograms (102 in never smokers and 97 in current smokers). Multivariate analysis of current smokers vs never smokers demonstrated that aneurysms in current smokers were significantly associated with multiple aneurysms (odds ratio [OR]: 2.15, P = .03), larger daughter vessel diameters (OR: 3.13, P = .01), larger size ratio (OR: 1.78, P = .01), and location at the basilar apex (OR: 6.26, P = .02). CONCLUSION The differences in aneurysm morphology between smoking and nonsmoking patient populations may elucidate the effects of smoking on aneurysm formation and eventual rupture. We identified several aspects of aneurysm morphology significantly associated with smoking status that may provide the morphological basis for how smoking leads to increased aneurysm rupture.
Collapse
Affiliation(s)
- Allen L Ho
- *Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | | | | | | |
Collapse
|
19
|
Can A, Mouminah A, Ho AL, Du R. Effect of Vascular Anatomy on the Formation of Basilar Tip Aneurysms. Neurosurgery 2014; 76:62-6; discussion 66. [DOI: 10.1227/neu.0000000000000564] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
BACKGROUND:
The pathogenesis of intracranial aneurysms is multifactorial and includes genetic, environmental, and anatomic influences. Hemodynamic stress plays a particular role in the formation of intracranial aneurysms, which is conditioned by the geometry and morphology of the vessel trees.
OBJECTIVE:
To identify image-based morphological parameters that correlated with the formation of basilar artery tip aneurysms (BTAs) in a location-specific manner.
METHODS:
Morphological parameters obtained from computed tomographic angiographies of 33 patients with BTAs and 33 patients with aneurysms at other locations were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined the diameters and vessel-to-vessel angles of the main vessels at the basilar bifurcation in patients with and without BTAs. To control for genetic and other risk factors, only patients with at least 1 aneurysm were included. Univariate and multivariate analyses were performed to determine statistical significance.
RESULTS:
Sixty-six patients (33 with BTAs, 33 with other aneurysms) who were evaluated from 2008 to 2013 were analyzed. Multivariate logistic regression revealed that a larger angle between the posterior cerebral arteries (odds ratio, 1.04; P = 1.42 × 10−3) and a smaller basilar artery diameter (odds ratio, 0.23; P = .02) were most strongly associated with BTA formation after adjustment for other morphological and clinical variables.
CONCLUSION:
Larger posterior cerebral artery angles and smaller basilar artery diameters are associated with the formation of basilar tip aneurysms. These parameters are easily measurable by the clinician and will aid in screening strategies in high-risk patients.
Collapse
Affiliation(s)
- Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amr Mouminah
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Allen L. Ho
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|