Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms

Clinical article

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  • 1 Department of Neurosurgery, and
  • 4 Surgical Planning Laboratory, Brigham and Women's Hospital;
  • 2 Harvard Medical School, Boston;
  • 5 Isomics, Inc., Cambridge, Massachusetts; and
  • 3 Department of Neurosurgery, The University of Texas Medical School at Houston, Texas
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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.

Abbreviations used in this paper:CTA = CT angiography; MCA = middle cerebral artery; MIP = maximum intensity projection; MRA = MR angiography; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address correspondence to: Rose Du, M.D., Ph.D., Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115. email: rdu@partners.org.

Please include this information when citing this paper: published online September 7, 2012; DOI: 10.3171/2012.7.JNS111766.

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