Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth

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  • 1 Mayo Medical School, Departments of Neuroradiology, Neurosurgery, and Neurology, and Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
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Object. Vertebrobasilar nonsaccular intracranial aneurysms (NIAs) are characterized by elongation, dilation, and tortuosity of the vertebrobasilar arteries. The goal of this study was to define the frequency, predictors, and clinical outcome of the enlargement of vertebrobasilar NIAs.

Methods. Patients with vertebrobasilar fusiform or dolichoectatic aneurysms demonstrated on imaging studies between 1989 and 2001 were identified. In particular, patients who had undergone serial imaging were included in this study and their medical records were retrospectively reviewed. Prospective information was collected from medical records or death certificates when available. Both initial and serial imaging studies were reviewed. The authors defined NIA enlargement as a change in lesion diameter greater than 2 mm or noted on the neuroradiologist's report. A Cox proportional hazards regression was used to model time from diagnosis of the vertebrobasilar NIA to the first documented enlargement as a function of various predictors. The Kaplan-Meier method was used to study patient death as a function of aneurysm growth.

Of the 159 patients with a diagnosis of vertebrobasilar NIA, 52 had undergone serial imaging studies including 25 patients with aneurysm enlargement. Lesion growth significantly correlated with symptomatic compression at the initial diagnosis (p = 0.0028), lesion type (p < 0.001), and the initial maximal lesion diameter (median 15 mm in patients whose aneurysm enlarged compared with median 8 mm in patients whose aneurysm did not enlarge; p < 0.001). The mortality rate was 5.7 times higher in patients with aneurysm growth than in those with no enlargement after adjustment for patient age (p = 0.002).

Conclusions. Forty-eight percent of vertebrobasilar NIAs demonstrated on serial imaging enlarged, and this growth was associated with significant morbidity and death. Significant risk factors for aneurysm enlargement included symptomatic compression at the initial diagnosis, transitional or fusiform vertebrobasilar NIAs, and initial lesion diameter. Further studies are necessary to determine appropriate treatments of this disease entity once enlargement has been predicted or occurs.

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Contributor Notes

Address reprint requests to: Kelly D. Flemming, M.D., Mayo Building, W8B, 200 First Street SW, Rochester, Minnesota 55905. email: Flemming.Kelly@mayo.edu.
  • 1.

    Anson JA, , Lawton MT, & Spetzler RF: Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185193, 1996 Anson JA, Lawton MT, Spetzler RF: Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193, 1996

    • Search Google Scholar
    • Export Citation
  • 2.

    Aoki N, , Sakai T, , Oikawa A, & Takizawa T: Giant unruptured aneurysm of the vertebral artery presenting with rapidly progressing bulbar compression—case report. Neurol Med Chir 37:907910, 1997 Aoki N, Sakai T, Oikawa A, Takizawa T: Giant unruptured aneurysm of the vertebral artery presenting with rapidly progressing bulbar compression—case report. Neurol Med Chir 37:907–910, 1997

    • Search Google Scholar
    • Export Citation
  • 3.

    Artmann H, , Vonofakos D, , Muller H, & Grau H: Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Review of the literature. Surg Neurol 21:391401, 1984 Artmann H, Vonofakos D, Muller H, Grau H: Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Review of the literature. Surg Neurol 21:391–401, 1984

    • Search Google Scholar
    • Export Citation
  • 4.

    Challa VR, & Moody DM: The value of magnetic resonance imaging in the detection of type II hemorrhagic lacunes. Stroke 20:822825, 1989 Challa VR, Moody DM: The value of magnetic resonance imaging in the detection of type II hemorrhagic lacunes. Stroke 20:822–825, 1989

    • Search Google Scholar
    • Export Citation
  • 5.

    Cohen MM, , Hemalatha CP, , D'Addario RT, & Goldman HW: Embolization from a fusiform middle cerebral artery aneurysm. Stroke 11:158161, 1980 Cohen MM, Hemalatha CP, D'Addario RT, Goldman HW: Embolization from a fusiform middle cerebral artery aneurysm. Stroke 11:158–161, 1980

    • Search Google Scholar
    • Export Citation
  • 6.

    Day AL, , Gaposchkin CG, , Yu CJ, , Rivet DJ, & Dacey RG Jr: Spontaneous fusiform middle cerebral artery aneurysms: characteristics and proposed mechanism of formation. J Neurosurg 99:228240, 2003 Day AL, Gaposchkin CG, Yu CJ, Rivet DJ, Dacey RG Jr: Spontaneous fusiform middle cerebral artery aneurysms: characteristics and proposed mechanism of formation. J Neurosurg 99:228–240, 2003

    • Search Google Scholar
    • Export Citation
  • 7.

    Drake CG, & Peerless SJ: Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87:141162, 1997 Drake CG, Peerless SJ: Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87:141–162, 1997

    • Search Google Scholar
    • Export Citation
  • 8.

    Flemming KD, , Link MJ, , Brown RD, , Huston J, & Wiebers DO: Presentation and long-term outcome in radiographically defined vertebrobasilar nonsaccular intracranial aneurysms (NIA). Stroke 34:275, 2003 (Abstract) Flemming KD, Link MJ, Brown RD, Huston J, Wiebers DO: Presentation and long-term outcome in radiographically defined vertebrobasilar nonsaccular intracranial aneurysms (NIA). Stroke 34:275, 2003 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 9.

    Flemming KD, , Link MJ, , Brown RD, , Huston J, & Wiebers DO: Prospective hemorrhage risk in radiographically defined vertebrobasilar nonsaccular intracranial aneurysms (NIA). Stroke 34:290, 2003 (Abstract) Flemming KD, Link MJ, Brown RD, Huston J, Wiebers DO: Prospective hemorrhage risk in radiographically defined vertebrobasilar nonsaccular intracranial aneurysms (NIA). Stroke 34:290, 2003 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 10.

    Gass A, & Hennerici MG: MRI of basilar-artery-aneurysm growth. Lancet Neurol 2:128, 2003 Gass A, Hennerici MG: MRI of basilar-artery-aneurysm growth. Lancet Neurol 2:128, 2003

    • Search Google Scholar
    • Export Citation
  • 11.

    Giang DW, , Perlin SJ, , Monajati A, , Kido DJ, & Hollander J: Vertebrobasilar dolichoectasia: assessment using MR. Neuroradiology 30:518523, 1988 Giang DW, Perlin SJ, Monajati A, Kido DJ, Hollander J: Vertebrobasilar dolichoectasia: assessment using MR. Neuroradiology 30:518–523, 1988

    • Search Google Scholar
    • Export Citation
  • 12.

    Hecht ST, , Horton JA, & Yonas H: Growth of a thrombosed giant vertebral artery aneurysm after parent artery occlusion. AJNR 12:449451, 1991 Hecht ST, Horton JA, Yonas H: Growth of a thrombosed giant vertebral artery aneurysm after parent artery occlusion. AJNR 12:449–451, 1991

    • Search Google Scholar
    • Export Citation
  • 13.

    Hoh BL, , Putman CM, , Budzik RF, , Carter BS, & Ogilvy CS: Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization. J Neurosurg 95:2435, 2001 Hoh BL, Putman CM, Budzik RF, Carter BS, Ogilvy CS: Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization. J Neurosurg 95:24–35, 2001

    • Search Google Scholar
    • Export Citation
  • 14.

    Iwama T, , Andoh T, , Sakai N, , Iwata T, , Hirata T, & Yamada H: Dissecting and fusiform aneurysms of vertebro-basilar systems. MR imaging. Neuroradiology 32:272279, 1990 Iwama T, Andoh T, Sakai N, Iwata T, Hirata T, Yamada H: Dissecting and fusiform aneurysms of vertebro-basilar systems. MR imaging. Neuroradiology 32:272–279, 1990

    • Search Google Scholar
    • Export Citation
  • 15.

    Johnston SC, , Halbach VV, , Smith WS, & Gress DR: Rapid development of giant fusiform cerebral aneurysms in angiographically normal vessels. Neurology 50:11631166, 1998 Johnston SC, Halbach VV, Smith WS, Gress DR: Rapid development of giant fusiform cerebral aneurysms in angiographically normal vessels. Neurology 50:1163–1166, 1998

    • Search Google Scholar
    • Export Citation
  • 16.

    Kaneko T, , Nomura M, , Yamashima T, , Suzuki M, & Yamashita J: Serial neuroimaging of a growing thrombosed giant aneurysm of the distal anterior cerebral artery—case report. Neurol Med Chir 41:3336, 2001 Kaneko T, Nomura M, Yamashima T, Suzuki M, Yamashita J: Serial neuroimaging of a growing thrombosed giant aneurysm of the distal anterior cerebral artery—case report. Neurol Med Chir 41:33–36, 2001

    • Search Google Scholar
    • Export Citation
  • 17.

    Katayama Y, , Tsubokawa T, , Miyazaki S, , Furnichi M, , Hirayama T, & Himi K: Growth of totally thrombosed giant aneurysm within the posterior cranial fossa. Diagnostic and therapeutic considerations. Neuroradiology 33:168170, 1991 Katayama Y, Tsubokawa T, Miyazaki S, Furnichi M, Hirayama T, Himi K: Growth of totally thrombosed giant aneurysm within the posterior cranial fossa. Diagnostic and therapeutic considerations. Neuroradiology 33:168–170, 1991

    • Search Google Scholar
    • Export Citation
  • 18.

    Koyama S, , Kotani A, & Sasaki J: Giant basilar artery aneurysm with intramural hemorrhage and then disastrous hemorrhage: case report. Neurosurgery 39:174178, 1996 Koyama S, Kotani A, Sasaki J: Giant basilar artery aneurysm with intramural hemorrhage and then disastrous hemorrhage: case report. Neurosurgery 39:174–178, 1996

    • Search Google Scholar
    • Export Citation
  • 19.

    Mizutani T, & Aruga T: Dolichoectatic intracranial vertebrobasilar dissecting aneurysm. Neurosurgery 31:765773, 1992 Mizutani T, Aruga T: Dolichoectatic intracranial vertebrobasilar dissecting aneurysm. Neurosurgery 31:765–773, 1992

    • Search Google Scholar
    • Export Citation
  • 20.

    Mizutani T, , Miki Y, , Kojima H, & Suzuki H: Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253260, 1999 Mizutani T, Miki Y, Kojima H, Suzuki H: Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–260, 1999

    • Search Google Scholar
    • Export Citation
  • 21.

    Nagahiro S, , Takada A, , Goto S, , Kai Y, & Ushio Y: Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg 82:796801, 1995 Nagahiro S, Takada A, Goto S, Kai Y, Ushio Y: Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg 82:796–801, 1995

    • Search Google Scholar
    • Export Citation
  • 22.

    Nagata I, , Kikuchi H, , Yamagata S, , Miyamoto S, , Kaneko T, & Asato R: [Intraluminal thrombosis and growth-mechanism of giant intracranial aneurysms.] No Shinkei Geka 18:11151120, 1990 (Jpn) Nagata I, Kikuchi H, Yamagata S, Miyamoto S, Kaneko T, Asato R: [Intraluminal thrombosis and growth-mechanism of giant intracranial aneurysms.] No Shinkei Geka 18:1115–1120, 1990 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 23.

    Nakatomi H, , Segawa H, , Kurata A, , Shiokawa Y, , Nagata K, & Kamiyama H, et al: Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896900, 2000 Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H, et al: Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896–900, 2000

    • Search Google Scholar
    • Export Citation
  • 24.

    Schubiger O, , Valavanis A, & Wichmann W: Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology 29:266271, 1987 Schubiger O, Valavanis A, Wichmann W: Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology 29:266–271, 1987

    • Search Google Scholar
    • Export Citation
  • 25.

    Seifert V, , Raabe A, & Stolke D: Management-related morbidity and mortality in unselected aneurysms of the basilar trunk and vertebrobasilar junction. Acta Neurochir 143:343349, 2001 Seifert V, Raabe A, Stolke D: Management-related morbidity and mortality in unselected aneurysms of the basilar trunk and vertebrobasilar junction. Acta Neurochir 143:343–349, 2001

    • Search Google Scholar
    • Export Citation
  • 26.

    Skirgaudas M, , Awad IA, , Kim J, , Rothbart D, & Criscuolo G: Expression of angiogenesis factors and selected vascular wall matrix proteins in intracranial saccular aneurysms. Neurosurgery 39:537547, 1996 Skirgaudas M, Awad IA, Kim J, Rothbart D, Criscuolo G: Expression of angiogenesis factors and selected vascular wall matrix proteins in intracranial saccular aneurysms. Neurosurgery 39:537–547, 1996

    • Search Google Scholar
    • Export Citation
  • 27.

    Smoker WR, , Corbett JJ, , Gentry LR, , Keyes WD, , Price MJ, & McKusker S: High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. AJNR 7:6172, 1986 Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S: High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review. AJNR 7:61–72, 1986

    • Search Google Scholar
    • Export Citation
  • 28.

    Steiger HJ, , Aaslid R, , Keller S, & Reulen HJ: Growth of aneurysms can be understood as passive yield to blood pressure. An experimental study. Acta Neurochir 100:7478, 1989 Steiger HJ, Aaslid R, Keller S, Reulen HJ: Growth of aneurysms can be understood as passive yield to blood pressure. An experimental study. Acta Neurochir 100:74–78, 1989

    • Search Google Scholar
    • Export Citation
  • 29.

    Yasui T, , Komiyama M, , Iwai Y, , Yamanaka K, , Nishikawa M, & Morikawa T: Evolution of incidentally-discovered fusiform aneurysms of the vertebrobasilar arterial system: neuroimaging features suggesting progressive aneurysm growth. Neurol Med Chir 41:523528, 2001 Yasui T, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M, Morikawa T: Evolution of incidentally-discovered fusiform aneurysms of the vertebrobasilar arterial system: neuroimaging features suggesting progressive aneurysm growth. Neurol Med Chir 41:523–528, 2001

    • Search Google Scholar
    • Export Citation
  • 30.

    Yasui T, , Sakamoto H, , Kishi H, , Komiyama M, , Iwai Y, & Yamanaka K, et al: Rupture mechanism of a thrombosed slow-growing giant aneurysm of the vertebral artery—case report. Neurol Med Chir 38:860864, 1998 Yasui T, Sakamoto H, Kishi H, Komiyama M, Iwai Y, Yamanaka K, et al: Rupture mechanism of a thrombosed slow-growing giant aneurysm of the vertebral artery—case report. Neurol Med Chir 38:860–864, 1998

    • Search Google Scholar
    • Export Citation

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