gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Pathoanatomical features of ruptured MCA mirror aneurysms compared to the non-ruptured side

Meeting Abstract

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  • Athanasios K. Petridis - Heinrich Heine University Duesseldorf, Department of Neurosurgery, Duesseldorf, Deutschland
  • Crescenzo Capone - Naples, Italy
  • Paolo Cappabianca - Università Degli Studi di Napoli Federico II, Dept of Neurosurgery, Naples, Italy
  • Ulrich Sure - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Hans-Jakob Steiger - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Homajoun Maslehaty - Kiel, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.01.06

doi: 10.3205/17dgnc358, urn:nbn:de:0183-17dgnc3582

Published: June 9, 2017

© 2017 Petridis 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

Text

Objective: The aim of this study was to define predictive pathoanatomical factors for rupture for middle cerebral artery (MCA) mirror bifurcation aneurysms.

Methods: Bicenter retrospective analysis of ruptured MCA bifurcation aneurysms with simultaneous presence of an un-ruptured MCA bifurcation mirror aneurysm. The parameters measured and analyzed with the statistic software R were: neck, dome and width of both MCA aneurysms including neck/dome and width/neck ratio, shape of the aneurysms (regular vs. irregular), inflow angle of both MCA aneurysms, diameter of bilateral A1 and M1 segments, the frontal and temporal M2 trunks, as well as the bilateral diameter of the carotid artery (ICA).

Results: N = 44 patients (15 male, 29 female, mean age 50.1 years) were analyzedThe size of the dome was highly significant (p=0.0000069). The size of the neck (p=0.0047940) and width of the aneurysms (p=0.0056902) and the aspect ratio, were at the stated significance level slightly non-significant. The shape of the aneurysms was bilaterally identical in 22 cases (50%). In cases of asymmetric presentation of the aneurysm shape, 19 (86.4%) ruptured aneurysms were irregular and 3 (13.6%) were regular shaped (p=0.001).

Conclusion: Extra-aneurysmal flow dynamics in mirror aneurysms are non-significant, and aneurysmal geometry does not seem to play a role as predictor for rupture. Only size and shape were predictors of aneurysm rupture. It seems like under same conditions one of the two aneurysms suffers changes in its wall and starts growing more or less stochastically. Newer imaging methods should enable us to see which aneurysm has an unstable wall in order to predict the rupture risk. In case of MCA mirror aneurysms the larger one with or without shape irregularities is the unstable aneurysm and this is the one which needs to be treated.