Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Size and Location of Ruptured Intracranial Aneurysms

  • Jeong, Young-Gyun (Department of Neurosurgery, Inje University College of Medicine, Busan Paik Hospital) ;
  • Jung, Yong-Tae (Department of Neurosurgery, Inje University College of Medicine, Busan Paik Hospital) ;
  • Kim, Moo-Seong (Department of Neurosurgery, Inje University College of Medicine, Busan Paik Hospital) ;
  • Eun, Choong-Ki (Department of Radiology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Jang, Sang-Hwan (Department of Occupational and Environmental Medicine, Inje University College of Medicine, Busan Paik Hospital)
  • Published : 2009.01.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location. Methods : We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital. Results : There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was $5.47{\pm}2.536\;mm$ in anterior cerebral artery (ACA), $6.84{\pm}3.941\;mm$ in ICA, $7.09{\pm}3.652\;mm$ in MCA and $6.21{\pm}3.697\;mm$ in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA. Conclusion : Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.

Keywords

References

  1. Asari S, Ohmoto T : Natural history and risk factors of unruptured cerebral aneurysms. Clin Neurol Neurosurg 95 : 205-214, 1993 https://doi.org/10.1016/0303-8467(93)90125-Z
  2. Atkinson JL, Sundt TM Jr, Houser OW, Whisnant JP : Angiographic frequency of anterior circulation intracranial aneurysms. J Neurosurg 70 : 551-555, 1989 https://doi.org/10.3171/jns.1989.70.4.0551
  3. Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, et al : Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke 30 : 905-915, 1999 https://doi.org/10.1161/01.STR.30.4.905
  4. Crompton MR : Mechanism of growth and rupture in cerebral berry aneurysms. Br Med J 1 : 1138-1142, 1996
  5. Dickey P, Kailasnath P : The diameter-cube hypothesis : a new biophysical model of aneurysm rupture. Surg Neurol 58 : 166-173 ; discussion173-180, 2002 https://doi.org/10.1016/S0090-3019(02)00848-0
  6. Ebina K, Shimizu T, Sohma M, Iwabuchi T : Clinicostatistical study on morphological risk factors of middle cerebral artery aneurysms. Acta Neurochir (Wien) 106 : 153-159, 1990 https://doi.org/10.1007/BF01809459
  7. Ferguson GG : Physical factors in the initiation, growth, and rupture of human intracranial aneurysms. J Neurosurg 37 : 666-677, 1972 https://doi.org/10.3171/jns.1972.37.6.0666
  8. Forget TR Jr, Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, et al : A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49 : 1322-1325 ; discussion 1325-1326, 2001 https://doi.org/10.1097/00006123-200112000-00006
  9. Horikoshi T, Akiyama I, Yamagata Z, Nukui H : Retrospective analysis of the prevalence of asymptomatic cerebral aneurysm in 4518 patients undergoing magnetic resonance angiography : when does cerebral aneurysm develop? Neurol Med Chir (Tokyo) 42 : 105-112; discussion 113, 2002 https://doi.org/10.2176/nmc.42.105
  10. International Study of Unruptured Intracranial Aneurysms Investigators : Unruptured intracranial aneurysms : natural history, clinical outcome, and risks of surgery and endovascular treatment. Lancet 362 : 103-110, 2003 https://doi.org/10.1016/S0140-6736(03)13860-3
  11. Juvela S, Porras M, Heiskanen O : Natural history of unruptured intracranial aneurysms : a long-term follow-up study. J Neurosurg 79 : 174-182, 1993 https://doi.org/10.3171/jns.1993.79.2.0174
  12. Juvela S, Porras M, Poussa K : Natural history of unruptured intracranial aneurysms : probability of and risk factors for aneurysm rupture. J Neurosurg 93 : 379-387, 2000 https://doi.org/10.3171/jns.2000.93.3.0379
  13. Kassell NF, Torner JC : Size of intracranial aneurysms. Neurosurgery 12 : 291-297, 1983 https://doi.org/10.1227/00006123-198303000-00007
  14. Kiyohara Y, Ueda K, Hasuo Y, Wada J, Kawano H, Kato I, et al : Incidence and prognosis of subarachnoid hemorrhage in a Japanese rural community. Stroke 20 : 1150-1155, 1989 https://doi.org/10.1161/01.STR.20.9.1150
  15. Kyriacou SK, Humphrey JD : Influence of size, shape and properties on the mechanics of axisymmetric saccular aneurysms. J Biomech 29 : 1015-1022, 1996 https://doi.org/10.1016/0021-9290(96)00010-3
  16. Locksley HB : Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg 25 : 321-368, 1966 https://doi.org/10.3171/jns.1966.25.3.0321
  17. McCormick WF, Acosta-Rua GJ : The size of intracranial saccular aneurysms : an autopsy study. J Neurosurg 33 : 422-427, 1970 https://doi.org/10.3171/jns.1970.33.4.0422
  18. Mitchell P, Gholkar A, Vindlacheruvu RR, Mendelow AD : Unruptured intracranial aneurysms : benign curiosity or ticking bomb? Lancet Neurol 3 : 85-92, 2004 https://doi.org/10.1016/S1474-4422(03)00661-6
  19. Mizoi K, Yoshimoto T, Nagamine Y, Kayama T, Koshu K : How to treat incidental cerebral aneurysms : a review of 139 consecutive cases. Surg Neurol 44 : 114-120; discussion 120-121, 1995 https://doi.org/10.1016/0090-3019(95)00035-6
  20. Ogilvy CS, Carter BS : Stratification of outcome for surgically treated unruptured intracranial aneurysm. Neurosurgery 52 : 82-87; discussion 87-88, 2003 https://doi.org/10.1097/00006123-200301000-00010
  21. Ohashi Y, Horikoshi T, Sugita M, Yagishita T, Nukui H : Size of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage. Surg Neurol 61 : 239-245 ; discussion 245-247, 2004 https://doi.org/10.1016/S0090-3019(03)00427-0
  22. Okuyama T, Sasamori Y, Takahashi H, Fukuyama K, Saito K : [Study of multiple cerebral aneurysms comprised of both ruptured and unruptured aneurysm-an analysis of incidence rate with respect to site and size] No Shinkei Geka 32 : 121-125, 2004
  23. Orz Y, Kobayashi S, Osawa M, Tanaka Y : Aneurysm size : a prognostic factor for rupture. Br J Neurosurg 11 : 144-149, 1997 https://doi.org/10.1080/02688699746500
  24. Park SD, Won YS, Kwon YJ, Yang JY, Choi CS : Angiographic characteristics of the intracranial saccular aneurysms to predict the rupture. Korean J Cerebrovasc Surg 9 : 87-93, 2007
  25. Qureshi AI, Sung GY, Suri MF, Straw RN, Guterman LR, Hopkins LN : Factors associated with aneurysm size in patients with subarachnoid hemorrhage : effect of smoking and aneurysm location. Neurosurgery 46 : 44-50, 2000 https://doi.org/10.1093/neurosurgery/46.1.44
  26. Rohde S, Lahmann K, Beck J, Nafe R, Yan B, Raabe A, et al : Fourier analysis of intracranial aneurysms : towards an objective and quantitative evaluation of the shape of aneurysms. Neuroradiology 47 : 121-126, 2005 https://doi.org/10.1007/s00234-004-1324-x
  27. Ronkainen A, Miettinen H, Karkola K, Papinaho S, Vanninen R, Puranen M, et al : Risk of harboring an unruptured intracranial aneurysm. Stroke 29 : 359-362, 1998 https://doi.org/10.1161/01.STR.29.2.359
  28. Rosen$\phi$rn J, Eskesen V : Does a safe-limit exist for unruptured intracranial aneurysms? Acta Neurochir (Wien) 121 : 113-118, 1993 https://doi.org/10.1007/BF01809260
  29. Rosen$\phi$rn J, Eskesen V, Schmidt K : Unruptured intracranial aneurysms : an assessment of the annual risk of rupture based on epidemiological and clinical data. Br J Neurosurg 2 : 369-377, 1988 https://doi.org/10.3109/02688698809001008
  30. Schievink WI, Piepgras DG, Wirth F : Rupture of previously documented small asymptomatic saccular intracranial aneurysms. J Neurosurg 76 : 1019-1024, 1992 https://doi.org/10.3171/jns.1992.76.6.1019
  31. Suzuki J, Ohara H : Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth. J Neurosurg 48 : 505- 514, 1978 https://doi.org/10.3171/jns.1978.48.4.0505
  32. Weir B, Disney L, Karrison T : Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 96 : 64-70, 2002 https://doi.org/10.3171/jns.2002.96.1.0064
  33. Wiebers DO, Whisnant JP, Sundt TM, O'Fallon WM : The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66 : 23-29, 1987 https://doi.org/10.3171/jns.1987.66.1.0023
  34. Wirth FP, Laws ER Jr, Piepgras D, Scott RM : Surgical treatment of incidental intracranial aneurysms. Neurosurgery 12 : 507-511, 1983 https://doi.org/10.1227/00006123-198305000-00005
  35. Yasui N, Magarisawa S, Suzuki A, Nishimura H, Okudera T, Abe T : Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms, a retrospective analysis of 25 cases. Neurosurgery 39 : 1096-1100; discussion 1100-1101, 1996 https://doi.org/10.1097/00006123-199612000-00004
  36. Yonekura M : Small unruptured aneurysm verification (SUAVe Study, Japan)-interim report. Neurol Med Chir (Tokyo) 44 : 213- 214, 2004 https://doi.org/10.2176/nmc.44.213
  37. Yoshimoto T, Mizoi K : Importance of management of unruptured cerebral aneurysms. Surg Neurol 47 : 522-525; discussion 525-526, 1997 https://doi.org/10.1016/S0090-3019(96)00400-4
  38. Zacks DJ, Russel DB, Miller JDR : Fortuitously discovered intracranial aneurysms. Arch Neurol 37 : 39-41, 1980 https://doi.org/10.1001/archneur.1980.00500500069010

Cited by

  1. Posterior Communicating Artery Aneurysms: Technical Pitfalls vol.20, pp.2, 2009, https://doi.org/10.1097/wnq.0b013e3181dcb2a0
  2. The role of the renin-angiotensin system in the pathogenesis of intracranial aneurysms vol.12, pp.3, 2011, https://doi.org/10.1177/1470320310387845
  3. Endovascular coil embolization of very small intracranial aneurysms vol.53, pp.5, 2009, https://doi.org/10.1007/s00234-010-0735-0
  4. Intracranial aneurysm segmentation in 3D CT angiography: Method and quantitative validation with and without prior noise filtering vol.79, pp.2, 2009, https://doi.org/10.1016/j.ejrad.2010.02.015
  5. Incidental aneurysms in temporal lobe epilepsy surgery: report of three cases and a review of the literature vol.26, pp.1, 2012, https://doi.org/10.3109/02688697.2011.601819
  6. Grading of Intracerebral Hemorrhage in Ruptured Middle Cerebral Artery Aneurysms vol.51, pp.5, 2009, https://doi.org/10.3340/jkns.2012.51.5.268
  7. Controversy: Clipping of Asymptomatic Intracranial Aneurysm That is <7 mm : Yes vol.44, pp.6, 2013, https://doi.org/10.1161/strokeaha.113.001786
  8. Sole Stenting Technique for the Treatment of Uncoilable Very Small Aneurysms in the Intracranial Internal Carotid Artery vol.53, pp.5, 2009, https://doi.org/10.2176/nmc.53.310
  9. Intracranial aneurysm size responsible for spontaneous subarachnoid haemorrhage vol.27, pp.1, 2009, https://doi.org/10.3109/02688697.2012.709559
  10. Modelling anisotropic material property of cerebral aneurysms for fluid-structure interaction simulation vol.1, pp.3, 2009, https://doi.org/10.1080/21681163.2013.776270
  11. Suggested Connections Between Risk Factors of Intracranial Aneurysms: A Review vol.41, pp.7, 2009, https://doi.org/10.1007/s10439-012-0723-0
  12. Physical Factors Effecting Cerebral Aneurysm Pathophysiology vol.41, pp.7, 2009, https://doi.org/10.1007/s10439-013-0800-z
  13. Moderately Elevated Intracranial Pressure Produces Greater Cross-Filling of the Anterior Communicating Artery vol.27, pp.4, 2009, https://doi.org/10.15274/nrj-2014-10064
  14. The Stent-Assisted Coil-Jailing Technique Facilitates Efficient Embolization of Tiny Cerebral Aneurysms vol.15, pp.6, 2014, https://doi.org/10.3348/kjr.2014.15.6.850
  15. The impact of size and location on rupture of intracranial aneurysms vol.10, pp.1, 2009, https://doi.org/10.4103/1793-5482.144159
  16. Intrasaccular Flow Disruption in Acutely Ruptured Aneurysms: A Multicenter Retrospective Review of the Use of the WEB vol.36, pp.9, 2009, https://doi.org/10.3174/ajnr.a4347
  17. Clinical Relevance of Haematologic Parameters in Predicting the Malignant Potential of Suspicious Renal Masses vol.15, pp.2, 2009, https://doi.org/10.1515/chilat-2016-0003
  18. Predictor and Prognosis of Procedural Rupture during Coil Embolization for Unruptured Intracranial Aneurysm vol.59, pp.1, 2009, https://doi.org/10.3340/jkns.2016.59.1.6
  19. Digital subtraction angiography findings and population demographics of patients with subarachnoidal haemorrhage and subsequent causative aneurysms at Universitas Academic Hospital, Bloemfontein vol.20, pp.1, 2009, https://doi.org/10.4102/sajr.v20i1.1030
  20. Assessment of intracranial aneurysm rupture based on morphology parameters and anatomical locations vol.8, pp.12, 2009, https://doi.org/10.1136/neurintsurg-2015-012112
  21. Stent-assisted coiling embolization of tiny, wide-necked intracranial aneurysms vol.159, pp.1, 2009, https://doi.org/10.1007/s00701-016-3022-y
  22. The Use of Flow Diverting Stents to Treat Para-Ophthalmic Aneurysms vol.8, pp.None, 2009, https://doi.org/10.3389/fneur.2017.00381
  23. Management paraophthalmischer Aneurysmen : Übersicht der endovaskulären Behandlungsstrategien vol.115, pp.2, 2009, https://doi.org/10.1007/s00347-017-0497-8
  24. Multiple intracranial aneurysms: a direct hemodynamic comparison between ruptured and unruptured vessel malformations vol.13, pp.1, 2009, https://doi.org/10.1007/s11548-017-1643-0
  25. Autonomous, Decentralized and Privacy-Enabled Data Preparation for Evidence-Based Medicine with Brain Aneurysm as a Phenotype vol.eb101, pp.8, 2018, https://doi.org/10.1587/transcom.2017adp0007
  26. Morphological parameters and anatomical locations associated with rupture status of small intracranial aneurysms vol.8, pp.None, 2018, https://doi.org/10.1038/s41598-018-24732-1
  27. Proportion of Variant Anatomy of the Circle of Willis and Association with Vascular Anomalies on Cerebral CT Angiography vol.2019, pp.None, 2019, https://doi.org/10.1155/2019/6380801
  28. Serum Cadmium Level Is Positively Associated with Unruptured Intracranial Aneurysm Incidence vol.40, pp.4, 2009, https://doi.org/10.4082/kjfm.17.0140
  29. Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH): uncertainty quantification of geometric rupture risk parameters vol.18, pp.None, 2019, https://doi.org/10.1186/s12938-019-0657-y
  30. Small Intracranial Aneurysms and Subarachnoid Hemorrhage: Is the Size Criterion for Risk of Rupture Relevant? vol.12, pp.suppl1, 2009, https://doi.org/10.1159/000503094
  31. Introducing the Rupture Criticality Index to Compare Risk Factor Combinations Associated With Aneurysmal Rupture vol.146, pp.None, 2021, https://doi.org/10.1016/j.wneu.2020.09.169
  32. Relationship between cerebral aneurysms and variations in cerebral basal arterial network: a morphometric cross-sectional study in Computed Tomography Angiograms from a neurointerventional unit vol.11, pp.9, 2009, https://doi.org/10.1136/bmjopen-2021-051028