Document Detail

Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms.
MedLine Citation:
PMID:  22957531     Owner:  NLM     Status:  MEDLINE    
OBJECT: Management of unruptured intracranial aneurysms remains controversial in neurosurgery. The contribution of morphological parameters has not been included in the treatment paradigm in a systematic manner or for any particular aneurysm location. The authors present a large sample of middle cerebral artery (MCA) aneurysms that were assessed using morphological variables to determine the parameters associated with aneurysm rupture.
METHODS: Preoperative CT angiography (CTA) studies were evaluated using Slicer software to generate 3D models of the aneurysms and their surrounding vascular architecture. Morphological parameters examined in each model included 5 variables already defined in the literature (aneurysm size, aspect ratio, aneurysm angle, vessel angle, and size ratio) and 3 novel variables (flow angle, distance to the genu, and parent-daughter angle). Univariate and multivariate statistical analyses were performed to determine statistical significance.
RESULTS: Between 2005 and 2008, 132 MCA aneurysms were treated at a single institution, and CTA studies of 79 aneurysms (40 ruptured and 39 unruptured) were analyzed. Fifty-three aneurysms were excluded because of reoperation (4), associated AVM (2), or lack of preoperative CTA studies (47). Ruptured aneurysms were associated with larger size, greater aspect ratio, larger aneurysm and flow angles, and smaller parent-daughter angle. Multivariate logistic regression revealed that aspect ratio, flow angle, and parent-daughter angle were the strongest factors associated with ruptured aneurysms.
CONCLUSIONS: Aspect ratio, flow angle, and parent-daughter angle are more strongly associated with ruptured MCA aneurysms than size. The association of parameters independent of aneurysm morphology with ruptured aneurysms suggests that these parameters may be associated with an increased risk of aneurysm rupture. These factors are readily applied in clinical practice and should be considered in addition to aneurysm size when assessing the risk of aneurysm rupture specific to the MCA location.
Ning Lin; Allen Ho; Bradley A Gross; Steven Pieper; Kai U Frerichs; Arthur L Day; Rose Du
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-09-07
Journal Detail:
Title:  Journal of neurosurgery     Volume:  117     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-02     Completed Date:  2013-01-08     Revised Date:  2013-11-08    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  913-9     Citation Subset:  AIM; IM    
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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MeSH Terms
Analysis of Variance
Aneurysm, Ruptured / radiography*,  surgery
Cerebral Angiography / methods
Image Processing, Computer-Assisted
Intracranial Aneurysm / radiography*,  surgery
Logistic Models
Middle Aged
Models, Neurological
Neurosurgical Procedures
Risk Factors
Tomography, X-Ray Computed
Comment In:
J Neurosurg. 2013 Oct;119(4):1077
J Neurosurg. 2012 Nov;117(5):911; discussion 911-2   [PMID:  22957523 ]
J Neurosurg. 2013 Oct;119(4):1077   [PMID:  23909247 ]

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