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Takeda N, Kurihara E, Kuroda R, Inoue S, Lee TJ, Nakahara M, Nakamura N, Sasayama T. Rupture Risk Factors and Strategies for Unruptured Distal Anterior Cerebral Artery Aneurysms. World Neurosurg 2024; 182:e785-e791. [PMID: 38092353 DOI: 10.1016/j.wneu.2023.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Distal anterior cerebral artery (dACA) aneurysms are rare. Ruptured dACA aneurysms typically present with subarachnoid hemorrhage in conjunction with intracerebral hematoma and cause neurological deterioration. This study aimed to determine their risk of rupture and examine associated factors. METHODS We retrospectively analyzed patients with dACA aneurysms to compare patient and aneurysm characteristics between ruptured and unruptured aneurysms. Clinical outcome was used the modified Rankin scale. Univariate analyses were performed to identify rupture risk factors. RESULTS One hundred three patients with dACA aneurysms were examined (51 ruptured and 52 unruptured). The median aspect ratio of ruptured and unruptured aneurysms was 1.69 and 1.22, respectively (P < 0.01). The median maximum diameter of ruptured and unruptured aneurysms was 5.2 and 3.1 mm, respectively (P < 0.01). The median size ratio of ruptured and unruptured aneurysms was 3.32 and 2.17, respectively (P < 0.01). Maximum diameter was <5 mm in 45.2% of ruptured dACA aneurysms. dACA aneurysm, showing size ratio >2.4 and aspect ratio >1.4, had ruptured in 71.4% and 78.6%, respectively. We suggested that these are the threshold of size ratio and aspect ratio for rupture of dACA aneurysms. A total percentatge of 78.1% of aneurysms with aspect ratio >1.4 and size ratio >2.4 had ruptured. CONCLUSIONS Distal anterior cerebral artery (dACA) aneurysms may rupture, even when small. We found a significant difference between ruptured and unruptured aneurysms with respect to maximum diameter, aspect ratio, and size ratio. Treatment for small aneurysms should be considered based on size ratio and aspect ratio, not just size.
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Affiliation(s)
- Naoya Takeda
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan.
| | - Eiji Kurihara
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Ryuichi Kuroda
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Satoshi Inoue
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Te-Jin Lee
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Masahiro Nakahara
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Naoto Nakamura
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University School of Medicine, Kakogawa, Hyogo, Japan
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Suzuki R, Takigawa T, Nagaishi M, Hyodo A, Suzuki K. Influence of size ratio on retreatment after coil embolization for unruptured bifurcation aneurysms. World Neurosurg X 2024; 21:100265. [PMID: 38173683 PMCID: PMC10762462 DOI: 10.1016/j.wnsx.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Aneurysm size is considered a risk factor for aneurysm rupture, and even small aneurysms may rupture, especially bifurcation aneurysms (BAs), which are occasionally detected. Therefore, we aimed to investigate the predictors of retreatment after coil embolization for unruptured BAs, with a particular focus on the absolute and relative size of the aneurysm (size ratio [SR]). Methods To evaluate the predictors of retreatment, patients were divided into two groups: those with and those without retreatment. Patient characteristics and radiographic assessments were compared between the groups. SR was defined as the ratio of the maximum aneurysm diameter and the average diameter of the parent artery. Results Overall, 181 unruptured BAs in 176 patients were investigated. The mean age of the patients was 63.8 ± 9.6 years. The mean aneurysm size and SR were 7.18 ± 2.94 mm and 2.49 ± 1.32, respectively. Further, 12 aneurysms with retreatment (6.6 %) and 169 aneurysms without retreatment were compared. In univariate analysis, SR was significantly higher in the group with retreatment (P = 0.02), but aneurysm size was not significantly different between the groups (P = 0.09). Multivariable analysis revealed that SR > 2.6 was a significant predictor of retreatment (P = 0.03; odds ratio: 10.41; 95 % confidence interval: 2.1-51.73). Conclusions This study showed that SR influences retreatment after coil embolization for unruptured BAs. Therefore, if the aneurysm size and parent artery diameter were small, as in cases with a large SR, meticulous follow-up after coil embolization is required to detect recurrence and recanalization.
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Affiliation(s)
- Ryotaro Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Masaya Nagaishi
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya City, Saitama, 343-8555, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya City, Saitama, 343-8555, Japan
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Geng J, Wang S, Wang Y, Wang W, Fang G, Yang G, Fan X, Hu P, He C, Zhang H. Clinical, 3D Morphological, and Hemodynamic Risk Factors for Instability of Unruptured Intracranial Aneurysms. Clin Neuroradiol 2023; 33:1133-1142. [PMID: 37318560 DOI: 10.1007/s00062-023-01324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Neurosurgeons can manage unruptured intracranial aneurysms (UIAs). However, the stability of UIAs under follow-up remains uncertain. This study aimed to examine the risk factors associated with the instability (rupture or growth) of UIAs during follow-up. METHODS We obtained information on patients with UIA who underwent ≥ 6 months of the time of flight-magnetic resonance angiography (TOF-MRA) imaging follow-up in two centers. Computer-assisted semi-automated measurement (CASAM) techniques were used for recording morphological parameters and determining the growth of these aneurysms. We also recorded hemodynamic parameters at the beginning of the follow-up. The univariate and multivariate Cox regression analyses were performed to calculate hazard ratios with corresponding 95% confidence intervals for the clinical, morphological, and hemodynamic risk factors for aneurysm instability. RESULTS A total of 304 aneurysms from 263 patients (80.4%) were included for analysis. The annual aneurysm growth rate was 4.7%. Significant predictive factors for aneurysm instability in the multivariate analysis were as follows: poorly controlled hypertension (hazard ratio (HR), 2.97 (95% CI, 1.27-6.98), P = 0.012); aneurysms located on posterior circulation (HR, 7.81 (95% CI, 2.28-26.73), P = 0.001), posterior communication artery (HR, 3.01 (95% CI, 1.07-8.46), P = 0.036), and cavernous carotid artery (HR, 3.78 (95% CI, 1.18-12.17), P = 0.026); and size ratio ≥ 0.87 (HR, 2.54 (95% CI, 1.14-5.68), P = 0.023). CONCLUSIONS The management of UIAs should focus on the control of hypertension during the follow-up. Aneurysms on the posterior communicating artery, posterior circulation, and cavernous carotid arteries require intensive surveillance or timely treatment.
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Affiliation(s)
- Jiewen Geng
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Simin Wang
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Yadong Wang
- Department of Neurosurgery, Weihai Municipal Hospital, Weihai, China
| | - Wenzhi Wang
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Gang Fang
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Guangming Yang
- Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China
| | - Xinxin Fan
- Department of Neurosurgery, Xi'an NO. 3 Hospital the Affiliated Hospital of Northwest University, Xi'an, China
| | - Peng Hu
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
- China International Neuroscience Institute, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China.
- China International Neuroscience Institute, Beijing, China.
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Hu Z, Zhang X, Gao S, Yuan Z, Lin Y, Chu F, Wu X. Axial spreading of droplet impact on ridged superhydrophobic surfaces. J Colloid Interface Sci 2021; 599:130-139. [PMID: 33933788 DOI: 10.1016/j.jcis.2021.04.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/17/2022]
Abstract
HYPOTHESIS Due to the complex hydrodynamics of droplet impact on ridged superhydrophobic surfaces, quantitative droplet spreading characteristics are unrevealed, limiting the practical applications of ridged superhydrophobic surfaces. During droplet impacting, the size ratio (the ratio of the ridge diameter to the droplet diameter) is an important factor that affects droplet spreading dynamics. EXPERIMENTS We fabricated ridged superhydrophobic surfaces with size ratios ranging from zero to one, and conduct water droplet impact experiments on these surfaces at varied Weber numbers. Aided by the numerical simulations and theoretical analysis, we illustrate the droplet spreading dynamics and reveal the law on the maximum axial spreading coefficient. FINDS The results show that the droplet spreading and retraction dynamics on ridged superhydrophobic surfaces are significantly asymmetric in the axial and spanwise directions. Focusing on the maximum axial spreading coefficient, we find it decreases first and then increases with increasing size ratios, indicating the existence of the critical size ratio. The maximum axial spreading coefficient can be reduced by 25-40% at the critical size ratio compared with that on flat surfaces. To predict the maximum axial spreading coefficient, two theoretical models are proposed respectively for size ratios smaller and larger than the critical size ratio.
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Affiliation(s)
- Zhifeng Hu
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Department of Energy and Power Engineering, Tsinghua University, Beijing 100084, China
| | - Xuan Zhang
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Department of Energy and Power Engineering, Tsinghua University, Beijing 100084, China
| | - Sihang Gao
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Department of Energy and Power Engineering, Tsinghua University, Beijing 100084, China
| | - Zhiping Yuan
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Department of Energy and Power Engineering, Tsinghua University, Beijing 100084, China
| | - Yukai Lin
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Department of Energy and Power Engineering, Tsinghua University, Beijing 100084, China
| | - Fuqiang Chu
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China.
| | - Xiaomin Wu
- Key Laboratory for Thermal Science and Power Engineering of Ministry of Education, Beijing Key Laboratory for CO(2) Utilization and Reduction Technology, Department of Energy and Power Engineering, Tsinghua University, Beijing 100084, China.
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Zhai XD, Yu JX, Li CJ, Ren J, Ji Z, He C, Ye M, Hu P, Zhang HQ. Morphological Characteristics of Pericallosal Artery Aneurysms and Their High Propensity for Rupture. World Neurosurg 2019; 133:e320-e326. [PMID: 31520758 DOI: 10.1016/j.wneu.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Compared with intracranial aneurysms (IAs) at other locations, pericallosal artery aneurysms (PAAs) have demonstrated an extremely high risk of rupture. However, owing to their rarity, our understanding of their morphological characteristics has been limited, and whether the morphological characteristics of PAAs contribute to this high rupture risk has remained unexplored. In the present study, we aimed to provide a detailed description of the morphological characteristics of PAAs and investigate the association between its morphology and rupture risk compared with anterior circulation IAs at other locations. METHODS A total of 40 patients with 45 PAAs and 348 patients with 392 anterior circulation IAs at other locations were recruited. The clinical and radiological data for these patients were retrospectively reviewed. The differences in the morphological parameters, including the aneurysm diameter, neck width, height, width, parent artery diameter, inflow angle, aspect ratio (AR), size ratio (SR), and aneurysm diameter/width ratio, between PAAs and other IA groups were compared. RESULTS Of the 45 PAAs, 22 (48.9%) had ruptured. The proportion of ruptured aneurysms was greater for PAAs than for anterior circulation IAs at other locations. For both ruptured and unruptured anterior circulation IAs, PAAs had the highest AR and SR among all IA groups and had the largest inflow angle. CONCLUSION The morphological characteristics of PAAs are unique. Compared with other anterior circulation IAs, PAAs have significantly increased ARs, SRs, and inflow angles, which, ultimately, promote their high propensity toward rupture.
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Affiliation(s)
- Xiao-Dong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Chuan-Jie Li
- Department of Neurosurgery, Shunyi District Hospital, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Zhe Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China.
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Hoffman H, Toshkezi G, Swarnkar A, Gould G, Chin LS, Krishnamurthy S. A retrospective comparison of sac and lobe morphology between ruptured and unruptured intracranial aneurysms. J Clin Neurosci 2018; 60:88-92. [PMID: 30309802 DOI: 10.1016/j.jocn.2018.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022]
Abstract
There are few reliable morphologic indices to aid in the determination of an intracranial aneurysm's rupture risk. We sought to characterize morphological characteristics of aneurysm sacs and their lobes that are associated with ruptured status at time of initial evaluation with diagnostic angiography. These factors could be associated with an aneurysm's risk of rupturing. We retrospectively reviewed all aneurysms imaged with digital subtraction angiography (DSA) at a single institution over five years. Patients presenting with aneurysmal subarachnoid hemorrhage (aSAH) were assigned to the ruptured group, and those presenting without aSAH were assigned to the unruptured group. Angiograms were evaluated for the presence of various morphological parameters. Binary logistic regression was used to assess their associations between groups. A total of 331 aneurysms among 241 patients were included in the analysis. Posterior circulation, larger size ratio, and the presence of two or more lobes were associated with aneurysm rupture (p < 0.001 for each). Aneurysms containing a lobe with a greater height than width were observed more frequently in the ruptured group (OR 5.26, 95% CI 2.66-10.41). In the receiver operating characteristic (ROC) curves, mean diameter had an AUC of 0.72 and an optimum threshold of 2.85 mm. For size ratio, the AUC was 0.70 and the optimum threshold was 2.02. A larger SR was observed in ruptured aneurysms. The presence of multiple lobes and greater lobe height than width were associated with rupture status as well. These factors merit investigation in a prospective study.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA.
| | - Gentian Toshkezi
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Amar Swarnkar
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Grahame Gould
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Lawrence S Chin
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Satish Krishnamurthy
- Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY, USA
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Matsukawa H, Kamiyama H, Miyazaki T, Kinoshita Y, Ota N, Noda K, Shonai T, Takahashi O, Tokuda S, Tanikawa R. Surgical Treatment of Middle Cerebral Artery Aneurysms: Aneurysm Location and Size Ratio as Risk Factors for Neurologic Worsening and Ischemic Complications. World Neurosurg 2018; 117:e563-e570. [PMID: 29929026 DOI: 10.1016/j.wneu.2018.06.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Regardless of acceptable surgical results of middle cerebral artery aneurysms (MCAs), MCA territory infarction (MCATI) remains a major obstacle to achieving a good outcome. We investigated the MCATI in patients with surgically treated MCA aneurysms. METHODS The data of 286 consecutive patients with 322 MCA aneurysms were evaluated retrospectively. The aneurysm location was classified as early frontal cortical branch (EFCB), early temporal cortical branch (ETCB), bifurcation or trifurcation (M1-2), and distal aneurysms on the insular, opercular, or cortical segments of the MCA (distal MCA). Neurologic worsening was defined as an increase in 1 or more modified Rankin Scale (mRS) scores. RESULTS Multivariate analysis identified EFCB location as the sole risk factor for MCATI (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.2-12; P = 0.021) and MCATI (OR, 18; 95% CI, 2.8-117; P = 0.002) and a larger size ratio (OR, 1.4; 95% CI, 1.1-1.8; P = 0.019) were related to 12-month neurologic worsening (n = 6; 1.9%). During follow-up (median, 885 days; interquartile range, 485-1229 days), posttreatment rupture and aneurysm recurrence were not observed. CONCLUSIONS In the present study, compared with M1-2 aneurysms, MCATIs were observed more frequently in EFCB aneurysms, and the presence of MCATI and a larger size ratio were related to 12-month neurologic worsening in patients with surgically treated MCA aneurysms.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takaharu Shonai
- Department of Radiology, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
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Chen XL, Chen Y, Ma L, Burkhardt JK, Wardell T, Wang C, Guo G, Wang S, Zhao YL. Translucent Appearance of Middle Cerebral Artery Bifurcation Aneurysms Is Risk Factor for Intraoperative Aneurysm Rupture During Clipping. World Neurosurg 2017; 101:149-154. [PMID: 28189862 DOI: 10.1016/j.wneu.2017.01.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The rupture rate of unruptured intracranial aneurysms is influenced by certain angioarchitectural and hemodynamic characteristics. Recently the translucent appearance of aneurysms was described as a possible risk factor for aneurysm rupture. In this study, we investigate the intraoperative rupture risk of surgically clipped unruptured translucent aneurysms (TAs). METHOD Clinical and radiologic data of microsurgically treated unruptured middle cerebral artery (MCA) bifurcation aneurysms between 2013 and 2015 were collected and analyzed. Aneurysms were divided into TA as defined as >90% reddish pigmentation appearance of the aneurysm wall or non-TA (NTA) according to the observation under microscope by a single neurosurgeon. Parameters were analyzed using univariate and multivariate statistical analyses. RESULT A total of 41 unruptured MCA bifurcation aneurysms were included in the analysis, and 68.2% (28/41) were defined as TA. The univariate analysis showed that aneurysm characteristics (Dmax, Wmax, height, and lower size ratio [SR]) that were small in nature were associated with TAs. TAs were associated with intraoperative rupture (28.6% vs. 0%, P = 0.04). Multivariate logistic regression analysis found that the lower SR is the independent risk factor for TAs. CONCLUSION The results demonstrate that a lower SR correlates with TA in the MCA bifurcation and the thinner wall of the TA causes intraoperative rupture more likely. These results provide important information on the fragility of TAs and might influence the treatment decisions in unruptured MCA bifurcation aneurysms with lower SRs.
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Affiliation(s)
- Xiao-Lin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, P. R. China
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China
| | - Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | | | - Chao Wang
- Department of Neurosurgery, Affiliated Hospital, Binzhou Medical University, Binzhou, Shandong, China
| | - Geng Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, P. R. China
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, P. R. China.
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Farnoush A, Avolio A, Qian Y. A growth model of saccular aneurysms based on hemodynamic and morphologic discriminant parameters for risk of rupture. J Clin Neurosci 2014; 21:1514-9. [PMID: 24929861 DOI: 10.1016/j.jocn.2013.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
The aim of this study was to derive a model describing the evolution of bifurcation type cerebral aneurysms based on morphological and hemodynamic parameters. Idealized bifurcation models were constructed based on the two morphological parameters of aspect ratio (AR) and size ratio (SR). Aneurysm development was investigated according to the following four patterns: R1, increasing SR with constant AR; R2, increasing AR with constant SR; R3, increasing SR and increasing AR; R4, increasing AR with constant parent artery diameter. Relationships were obtained between energy loss (EL) and morphological parameters (EL-SR and EL-AR curves). The curves were validated by mapping the growth of a ruptured patient-specific bifurcation aneurysm at three stages of follow-up. EL increased in parallel with growth patterns R1 and R3, whereas growth pattern R2 showed a decrease in EL. No significant changes were observed in EL when the growth of the aneurysm was associated only with changes in aneurysm size and independent of changes in parent artery diameter and main flow (R4). Changes in parent artery diameter of bifurcation aneurysms resulted in significant variation in EL. Mapping the growth of a follow-up aneurysm onto the EL-AR curve demonstrated that aneurysms with increasing EL during the observation period are at higher risk of rupture than aneurysms with decreasing EL. Based on the proposed growth model, assessment of morphological (AR and SR) and hemodynamic (EL) parameters may provide quantifiable information on the risk of bifurcation aneurysm rupture during clinical patient follow-up.
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Affiliation(s)
- Azadeh Farnoush
- The Australian School of Advanced Medicine, Macquarie University, 2 Technology Place, Macquarie Park, NSW 2113, Australia.
| | - Alberto Avolio
- The Australian School of Advanced Medicine, Macquarie University, 2 Technology Place, Macquarie Park, NSW 2113, Australia
| | - Yi Qian
- The Australian School of Advanced Medicine, Macquarie University, 2 Technology Place, Macquarie Park, NSW 2113, Australia
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Hirvonen H, Ranta E. Prey to predator size ratio influences foraging efficiency of larval Aeshna juncea dragonflies. Oecologia 1996; 106:407-415. [PMID: 28307329 DOI: 10.1007/bf00334569] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/1995] [Accepted: 11/20/1995] [Indexed: 10/26/2022]
Abstract
We investigated foraging behaviour of larval dragonflies Aeshna juncea in order to examine the significance of prey density and body size in predator-prey dynamics. A. juncea were offered separately three size-classes of Daphnia magna at low and high densities. The data were collected with direct observations of the foraging individuals. We found that large A. juncea larvae could better enhance their intake of prey biomass as prey size and prey density increased than their smaller conspecifics. However, increasing feeding efficiency of both larval instars was constrained by declining attack success and search rate with increasing prey size and density. With small D. magna, in contrast to large A. juncea, small A. juncea increased their searching efficiency as prey density increased keeping D. magna mortality rate at a constant level. In a predator-prey relationship this indicates stabilizing potential and feeding thresholds set by both prey density and prey-predator size ratio. Attack success dropped with prey size and density, but did not change in the course of the foraging bout. For both A. juncea sizes prey handling times increased as more medium and large prey were eaten. The slope of the increase became steeper with increasing prey-predator size ratio. These observations indicate that components of the predator-prey relationship vary with prey density, contrary to the basic assumptions of functional response equations. Moreover, the results suggest that the effects of prey density change during the ontogeny of predators and prey.
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Affiliation(s)
- Heikki Hirvonen
- Integrative Ecology Unit, Division of Population Biology, Department of Ecology and Systematics, University of Helsinki, P.O. Box 17, FIN-00014, Finland.
| | - Esa Ranta
- Integrative Ecology Unit, Division of Population Biology, Department of Ecology and Systematics, University of Helsinki, P.O. Box 17, FIN-00014, Finland
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Abstract
I investigated morphological pattern and preysize preference of three bird assemblages (14 species altogether) in a Hungarian oak forest, during the breeding seasons of 1979-1986. To assess the occurrence of competition for food among forest birds I performed a 5-year removal experiment with two hole-nesting passerines, the great tit and the blue tit. Prey preference of both species was affected by the presence of the other species. The results of both the removal experiment and the estimation of available food supply indicated food limitation, at least for foliage-gleaning birds. However, I found neither a regular size ratio among species nor a strong relationship between predator size and prey size. Other phenomena such as foraging strategies may affect preysize preference. Therefore, a competition model including only morphological ratios and predator-prey size relationships is too simplified.
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Affiliation(s)
- János Török
- Behavioral Ecology Group, Department of Systematic Zoology & Ecology, Eötvös University, Puskin u. 3., H-1088, Budapest, Hungary
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