Hidetoshi Matsukawa, Akihiro Uemura, Motoharu Fujii, Minobu Kamo, Osamu Takahashi and Sosuke Sumiyoshi
Patients with ruptured anterior communicating artery (ACoA) aneurysms have historically been observed to have poor neuropsychological outcomes, and ACoA aneurysms have accounted for a higher proportion of ruptured than unruptured aneurysms. Authors of this study aimed to investigate the morphological and clinical characteristics predisposing to ACoA aneurysm rupture.
Data from 140 consecutive patients with ACoA aneurysms managed at the authors' facility between July 2003 and November 2011 were retrospectively reviewed. Patients with (78) and without (62) aneurysm rupture were divided into groups, and morphological and clinical characteristics were compared. Morphological characteristics were evaluated based on 3D CT angiography and included aneurysm location, dominance of the A1 portion of the anterior cerebral artery, direction of the aneurysm dome around the ACoA, aneurysm bleb(s), size of the aneurysm and its neck, aneurysm–parent artery angle, and existence of other intracranial unruptured aneurysms.
Patients with ruptured ACoA aneurysms were significantly younger (a higher proportion were younger than 60 years of age) than those with unruptured lesions, and a significantly smaller proportion had hypercholesterolemia. A significantly larger proportion of patients with ruptured aneurysms showed an anterior direction of the aneurysm dome around the ACoA, had a bleb(s), and/or had an aneurysm size ≥ 5 mm. Multivariate logistic regression analysis showed that an anterior direction of the aneurysm dome around the ACoA (OR 6.0, p = 0.0012), the presence of a bleb(s) (OR 22, p < 0.0001), and an aneurysm size ≥ 5 mm (OR 3.16, p = 0.035) were significantly associated with ACoA aneurysm rupture.
Findings in the present study demonstrated that the anterior projection of an ACoA aneurysm may be related to rupturing. The authors would perhaps recommend treatment to patients with unruptured ACoA aneurysms that have an anterior dome projection, a bleb(s), and a size ≥ 5 mm.
Hidetoshi Matsukawa, Masaki Shinoda, Motoharu Fujii, Osamu Takahashi, Atsushi Murakata, Daisuke Yamamoto, Sosuke Sumiyoshi and Ryoichi Ishikawa
Intraventricular hemorrhage (IVH) is widely regarded as one element of a complex involving severe blunt traumatic brain injury (TBI); corpus callosum injury (CCI) is recently considered to be one factor associated with poor outcome in patients with TBI. Although postmortem studies have focused on the relationship between IVH and CCI, there have been few investigations of IVH evidenced on CT scans as a predictor of CCI evidenced on MRI.
The authors retrospectively reviewed prospectively collected data from 371 patients with blunt TBI, without trauma to the face, chest, abdomen, extremities, or pelvic girdle, requiring immediate therapeutic intervention. Their aim was to investigate whether IVH found on CT predicts CCI on MRI. Clinical and radiological data were collected between June 2003 and February 2011. First, the authors classified patients into groups of those with CCI and those without CCI, and they compared clinical and radiological findings between them. Then, they investigated prognostic factors that were related to the development of disability at 6 months after injury. The outcomes at 6 months after injury were evaluated using the Extended Glasgow Outcome Scale (GOS-E). Finally, the authors evaluated the correlation between the severity of the IVH on CT and the number of CCI lesions on MRI. The severity of the IVH was defined by the number of ventricles in which IVH was seen, and the number of CCI lesions was counted on the MRI study.
On multivariate logistic regression analysis, Glasgow Coma Scale score less than 9 (OR 2.70 [95% CI 1.10–6.27]), traffic accident (OR 2.59 [95% CI 1.37–4.93]), and IVH on CT (OR 3.31 [95% CI 1.25–8.49]) were significantly related to CCI. Multivariate analysis also showed that older age (p = 0.0001), male sex (OR 3.26 [95% CI 1.46–8.08], p = 0.0065), Glasgow Coma Scale score less than 9 (OR 8.27 [95% CI 3.39–21.4], p < 0.0001), evidence of IVH on CT (OR 4.09 [95% CI 1.45–11.9], p = 0.0081), and evidence of CCI on MRI (OR 8.32 [95% CI 3.89–18.8], p < 0.0001) were associated with future development of disability (GOS-E score ≤6). Furthermore, simple regression analysis revealed the existence of a strong correlation between the severity of IVH and the number of CCI lesions (r = 0.0668, p = 0.0022).
The authors' results suggest that evidence of IVH on CT may indicate CCI, which can lead to disability in patients with isolated blunt TBI.