gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Incidental insight into aneurysm growth: de novo formation and growth of a ruptured anterior communicating artery aneurysm documented with magnetic resonance angiographies in a patient with no prior history of intracranial aneurysm

Meeting Abstract

  • A. Patrona - Neurochirurgische Klinik, Klinikum Fulda
  • H. Füssler - Neurochirurgische Klinik, Klinikum Fulda
  • E. Hofmann - Neuroradiologische Abteilung, Klinikum Fulda
  • R. Behr - Neurochirurgische Klinik, Klinikum Fulda

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 042

doi: 10.3205/11dgnc263, urn:nbn:de:0183-11dgnc2635

Published: April 28, 2011

© 2011 Patrona et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Saccular aneurysms are thought to develop during early adulthood; the precise age of individual formation is unknown. In the field of aneurysm formation and growth rate, current assumptions rely on anecdotal data and mathematical modelling studies. We treated a patient with a first-time subarachnoidal hemorrhage (SAH) due to a ruptured saccular aneurysm, which previous magnetic resonance (MR)-angiographies did not show. Our objective is to illustrate this unusual case of aneurysm formation and growth to its rupture.

Methods: The 52-year-old male patient was admitted with acute deterioration after headaches over the past week. Cranial computed tomography (CCT) revealed a frontal hematoma and SAH in the interhemispheric fissure and anterior basal cistern. Conventional cerebral angiography confirmed the presence of a 7mm anterior communicating artery aneurysm and vasospasm of vessels of the anterior circulation. The patient was admitted to the intensive care unit. The aneurysm was surgically treated several days later after clinical stabilization. The patient’s history was positive for transitory ischemic incidents and a minor stroke. Known risk factors were a history of smoking and arterial hypertension. There was no history of previous intracranial surgery or SAH. In the neurovascular conference, prior MR-angiographies back to the year 2003 were provided. Retrospective analysis of the MR-angiographies from March 2003 and October 2009 was performed by experienced neuroradiologists and neurosurgeons.

Results: The MR-angiography from March 2003 shows normal findings. A further MR-angiography from October 2009, almost 12 months prior to the SAH, reveals a slight wall irregularity, less than an infundibulum, in the anterior communicating artery. Conventional present angiography and operative findings clearly demonstrate a typical saccular aneurysm arising at this location. On the individual level, a long period of practically no growth alternated with rapid irregular growth and high rupture risk, which ultimately lead to a severe SAH.

Conclusions: This case contributes to the growing evidence of implausibility of a constant aneurysm growth rate. False negative results in the detection of aneurysms with MR-angiography must of course be considered. However, de novo formation and growth in patients with no history of SAH or aneurysm may not be as rare as once thought. We also conclude that morphological data such as size and location for prediction of rupture risk of intracranial aneurysms may not be sufficient.