Article
On the role of the perianeurysmal environment regarding shape and rupture risk of cerebral berry aneurysms
Umgebungskontakte und ihre Rolle für die Formgebung und das Rupturrisiko zerebraler Aneurysmen
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Published: | May 8, 2006 |
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Objective: To evaluate whether interactions between intracranial cerebral berry aneurysms and the perianeurysmal environment (PEA) in the form of contact constraints, influence aneurysm shape and risk of rupture.
Methods: A total of 190 consecutive aneurysms, of which 124 were ruptured (group 1) and 66 were unruptured, (group 2) were studied. All aneurysms underwent high resolution angiography CT (HRCT). Aneurysm size and location, type of hemorrhage, initial Glasgow coma scale (GCS) rating, WFNS grade, Fisher grade, and presence of concomitant aneurysms was recorded. Contact constraints between aneurysms and anatomical structures of the PAE were identified for each aneurysm and further subdivided into balanced or unbalanced depending on whether contact constraints were thought to have a protective or a detrimental effect. Regular or irregular shape was recorded and correlated to contact constraints.
Results: Compared to unruptured aneurysms, ruptured aneurysms were found to be larger, more irregular, develop more contact constraints with the PAE, and showed higher rates of unbalanced contacts constraints. Ruptured aneurysms had a tendency to be found in locations of constraining PAE. Irregular shape was positively correlated with the presence of an unbalanced contact constraint, even in the absence of obvious contour deformations from an imprint of an adjacent structure.
Conclusions: Contact constraints between intracranial saccular aneurysms and the PAE were shown to influence shape and risk of aneurysm rupture. Modifications of wall shear stress by contact constraints are discussed. Analysis of contact constraints between aneurysm and the PAE could be considered as additional parameters in the assessment of the risk of aneurysm rupture.