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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Morphological features of ruptured cerebral aneurysms

Meeting Abstract

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  • Tammam Abboud - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Patrick Czorlich - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Maxim Bester - Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf
  • Nils Ole Schmidt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Manfred Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Jan Regelsberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMO.09.02

doi: 10.3205/15dgnc039, urn:nbn:de:0183-15dgnc0394

Published: June 2, 2015

© 2015 Abboud et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: According to ISUIA, cerebral aneurysms smaller than 7mm are believed to be associated with a low bleeding risk. However, other studies reported that a significant portion of ruptured aneurysms was smaller than 7 mm, which is in line with our clinical practice. The purpose of this study was to evaluate the morphology and location of ruptured aneurysms in correlation to their size.

Method: Between 11/2010 and 08/2014, 301 SAH-patients were admitted to our hospital. Two independent investigators reviewed the angiograms of ruptured aneurysms to assess location, maximal size and morphological features. Only patients with available 3-dimentional angiographic images were included. Aneurysm morphology was classified according to a predetermined protocol into single sac aneurysms with smooth margin, single sac aneurysms with irregular margins, aneurysms with daughter sac and multilobulated aneurysms. Aneurysms were divided into two groups <7mm and >7mm and evaluated for age, gender, location and morphology. Statistical analyzes were based on t-test and Chi-square test.

Results: 205 SAH-patients met the inclusion criteria (mean age 54yrs.). In 133 (65%) patients, aneurysm size was less than 7mm (maximal diameter) and in 62 (35%) patients greater than or equal to 7mm. Multilobulated aneurysms were the most frequent finding, followed by single sac with irregular margin, aneurysms with daughter sac and those with single sac and smooth margin (45%, 18%, 26% and 11%, respectively). No statically significant difference was found in the distribution of morphological findings when regarding aneurysm size (<7mm/ ≥7mm) and/or location (p>0,005). Aneurysms of the anterior cerebral artery were found to be rather smaller (<7mm) than MCA, ICA or posterior circulation aneurysms (p=0,002).

Conclusions: Small aneurysms <7mm, especially of the anterior cerebral artery, are more dangerous than shown in ISUIA. Morphological features of cerebral aneurysms do not seem suitable to serve as indicator for threatening aneurysm rupture to advise patients with non-ruptured aneurysms to get treatment. Here, further studies on aneurysmal wall will be necessary to elucidate aneurysm related factors predicting the likelihood of rupture.