Size of Intracranial Aneurysms

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 291-297 ◽  
Author(s):  
Neal F. Kassell ◽  
James C. Torner
Keyword(s):  
Intracranial Aneurysms ◽  
Optimal Time ◽  
Anterior Communicating Artery ◽  
Mortality And Morbidity ◽  
Unruptured Aneurysms ◽  
Computed Tomographic ◽  
Maximal Diameter ◽  
Median Diameter ◽  
Middle Cerebral Artery Aneurysms ◽  
Overall Mortality

Abstract Intracranial aneurysms are common lesions, occurring in as many as 2% of the age-corrected population of North America. Most aneurysms are small and innocuous, but some will enlarge and rupture. The clinical frequency of intact aneurysms has been increasing as a result of computed tomographic scanning and digital subtraction angiography, and this trend can be expected to accelerate in the future. Intact aneurysms are an important neurosurgical problem. Once an aneurysm ruptures, there is an associated 50 to 60% overall mortality and morbidity. In contrast, surgical correction of an unruptured aneurysm in skilled hands carries a mortality and morbidity of approximately 3%. Obviously, the optimal time for correction of aneurysm is before it ruptures. For effective management of patients with intact aneurysms, prognostic criteria for rupture are clearly needed. Aneurysm size is both theoretically and empirically a key prognostic factor for rupture. However, the critical size at which an aneurysm becomes hazardous is not known. The purpose of this investigation was to study the size of ruptured aneurysms in an attempt to infer the behavior of unruptured aneurysms. The angiographic size of aneurysms in the 1092 patients admitted to the Cooperative Aneurysm Study between 1970 and 1977 was measured. The average maximal diameter was 8.2 + 3.9 (SD) mm, and the median diameter was 7.0 mm. Seventy-one per cent of the sacs were smaller than 10 mm and 13% were less than 5 mm in diameter. Middle cerebral artery aneurysms were the largest and anterior communicating artery aneurysms were the smallest. These data suggest that aneurysms less than 1 cm in diameter are hazardous and that operation should be considered for lesions more than approximately 5 mm in diameter. Additional prognostic factors for rupture are clearly needed.

scholarly journals Diagnostic value of multidetector computed tomographic angiography in early diagnosis of intracranial aneurysms in the anterior communicating artery (ACoA)

2013 ◽  
Vol 60 (4) ◽  
pp. 71-75
Author(s):  
Igor Djoric ◽  
Djordjije Saranovic ◽  
Dragan Sagic ◽  
Vladimir Jovanovic ◽  
Igor Nikolic ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Clinical History ◽  
Diagnostic Value ◽  
Computed Tomographic Angiography ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Computed Tomographic ◽  
Real Risk ◽  
Risk Of Rupture ◽  
Tomographic Angiography

Multidetector computed tomographic angiography (MDCTA) is a non-invasive, highly sophisticated and readily available diagnostic method nowadays gained primacy in the algorithm of the blood vessels of the brain. MDCTA showed the highest sensitivity and specificity for early detection of ruptured intracranial aneurysms. Saccular aneurysm geometry (shape and size), anatomic localization, and patient-dependent factors individually and together determine the risk of rupture of the aneurysm. Unruptured aneurysms in anterior communicating artery showed twice the possibility of rupture than other intracranial aneurysms. Clinical history ACoA aneurysms after rupture is particularly difficult. This justifies the efforts to determine the real risk of these aneurysms when SAH was not found on the native scan endocranium. It is here that the diagnostic value and usefulness of MDCTA examination increases significantly and its true dimension.

scholarly journals Endovascular Treatment of Unruptured Intracranial Aneurysms

2011 ◽  
Vol 17 (4) ◽  
pp. 420-424 ◽  
Author(s):  
W. Yue
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Mortality And Morbidity ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Mean Size ◽  
Large And Giant Aneurysms ◽  
Brain Stem Ischemia

We report the clinical and angiographic results of endovascular treatment of unruptured intracranial aneurysms. Over a three-year period, 80 unruptured aneurysms in 74 patients were electively treated with endovascular management. One aneurysm was diagnosed during investigations for a second ruptured aneurysm, 54 aneurysms were incidentally discovered, 18 aneurysms presented with symptoms of mass effect and seven aneurysms presented with symptoms of brain stem ischemia. Mean size of the 80 unruptured aneurysms was 12.5±8.0 mm (range, 2–39 mm). Thirty-six aneurysms (45%) were small (<10 mm), 38 aneurysms (47.5%) were large (10–25 mm), and six aneurysms (7.5%) were giant (25–39 mm). Forty-eight wide-necked aneurysms (60%) were coiled with the aid of a supporting device. The mortality rate was 1.25%, and the overall morbidity was 1.25%. Of these, one of the patients suffered a stroke, leading to severe disability (1.25%). In one patient, the aneurysm ruptured during treatment, resulting in death. Initial aneurysm occlusion was complete (100%) in 76.25% aneurysms, nearly complete (90%–98%) in 10% aneurysms and incomplete (60%–85%) in 13.75% aneurysms. Follow-up angiography was available in 67 patients with 73 treated aneurysms (91.25%) from one to 36 months (mean 9.3 months); partial reopening occurred in 7.5%, mainly large and giant aneurysms (5.5%). Additional coiling was performed in four aneurysms. There were no complications in additional treatments. At 14.1-month clinical follow-up (range, 2 to 36 months), mRS score was 0 in 78.75% patients, 1 in 10% patients, 2 in 8.75% and 3 in 1.25%. There was no aneurysmal rupture during the follow-up period. Endovascular treatment of unruptured intracranial aneurysms has low procedural mortality and morbidity rates.

scholarly journals Unruptured intracranial aneurysms: natural history and management decisions

2004 ◽  
Vol 17 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Leodante B. da Costa ◽  
Thorsteinn Gunnarsson ◽  
M. Christopher Wallace
Keyword(s):  
Neurological Deficit ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
International Study ◽  
Special Importance ◽  
Surgical Morbidity ◽  
Mortality And Morbidity ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Aneurysmal subarachnoid hemorrhage (SAH) carries a grim prognosis, with high mortality and morbidity rates. The mortality rate in the first 30 days postrupture is estimated to be in the range of 40 to 50%, and almost half of the survivors will be left with a neurological deficit. Unlike patients with aneurysmal SAH, those with unruptured intracranial aneurysms usually experience no neurological deficit, and their treatment is prophylactic, aiming to reduce the risk of future bleeding and its consequences. The risk of rupture therefore assumes special importance when making decisions regarding which patient or aneurysm to treat. In previous reports the risk of bleeding for unruptured aneurysms has been stated as approximately 2% per year. The retrospective part of the International Study of Unruptured Intracranial Aneurysms (ISUIA) reported very low annual bleeding rates (0.05–1%) and high surgical morbidity and mortality rates (8–18%), prompting discussion in which the benefits of prophylactic treatment in the majority of these lesions were questioned. Prospective data from the second part of the ISUIA recently included rupture rates ranging from 0 to 10% per year. The aim of this paper was to review the evidence that is currently available for neurosurgeons to use when making decisions regarding patients who would benefit from treatment of an unruptured intracranial aneurysm.

scholarly journals Spontaneous Disappearance of Unruptured Intracranial Aneurysm: A Case Report

2021 ◽  
Vol 36 (2) ◽  
pp. 148-152
Author(s):  
Sang Hoon Jeong ◽  
Jung Hwan Lee ◽  
Tae Hong Lee ◽  
Chang Hwa Choi
Keyword(s):  
Intracranial Aneurysms ◽  
Rare Case ◽  
Unruptured Aneurysm ◽  
Spontaneous Resolution ◽  
Anterior Communicating Artery ◽  
Unruptured Intracranial Aneurysm ◽  
Related Literature ◽  
Unruptured Aneurysms ◽  
Spontaneous Disappearance ◽  
Ruptured Intracranial Aneurysms

Spontaneous resolution or thrombosis of giant or ruptured intracranial aneurysms is occasionally reported. However, spontaneous resolution of unruptured aneurysms without any intervention is extremely rare. Recently, we encountered a case of spontaneous resolution of a small unruptured aneurysm of the anterior communicating artery. We describe this rare case and discuss the mechanism of resolution with a review of the related literature.

In-Stent Thrombosis and Stenosis After Neck-Remodeling Device-Assisted Coil Embolization of Intracranial Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1523-1533 ◽  
Author(s):  
Hilal Kanaan ◽  
Brian Jankowitz ◽  
Aitziber Aleu ◽  
Dean Kostov ◽  
Ridwan Lin ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Anterior Communicating Artery ◽  
Complication Rates ◽  
Stent Patency ◽  
Unruptured Aneurysms ◽  
Short And Long Term ◽  
Stent Complications

Abstract BACKGROUND: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms. OBJECTIVE: To examine the technical and anatomic factors that predict short- and long-term stent patency. METHODS: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device. One hundred twenty-seven patients had catheter-based angiographic follow-up to evaluate 133 stent-coil constructs (mean, 15.4 months; median, 12.7 months). The technique of microcatheter jailing was used in a majority of patients; nonstandard stent configurations were also used. RESULTS: Clinical follow-up for all patients who had catheter-based angiograms demonstrated that among 133 stent constructs, a total of 9 (6.8%) had an in-stent event: 6 acute or subacute thrombosis (4.5%) and 3 delayed stenosis or occlusion (2.3%). Seven of these constructs were associated with a symptomatic event (5.3%). A significantly higher rate of in-stent events was seen with the use of constructs to treat anterior communicating artery aneurysms. When all patients are considered, including those who did not receive catheter-based follow-up imaging, 2 of 168 procedures (1.2%) resulted in the death of a patient, and procedural morbidity was 14.9%. CONCLUSION: From these results and those in the published literature, in-stent complication rates are low in carefully selected patients. The use of dual antiplatelet therapy, sensitivity assays, and glycoprotein IIb/IIIa inhibitors may decrease the rate of acute and chronic in-stent complications.

Superciliary Keyhole Approach for Small Unruptured Aneurysms in Anterior Cerebral Circulation

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons300-ons309 ◽  
Author(s):  
Jaechan Park ◽  
Hyunjin Woo ◽  
Dong-Hun Kang ◽  
Joo-Kyung Sung ◽  
Yongsun Kim
Keyword(s):  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Control Group ◽  
Anterior Communicating Artery ◽  
Consecutive Series ◽  
Pterional Approach ◽  
Unruptured Aneurysms ◽  
Operative Duration ◽  
Unruptured Intracranial Aneurysms ◽  
Keyhole Approach

Abstract Background: Neurovascular surgeons have been trying to find a solution to the problem of surgical invasiveness by applying minimally invasive keyhole approaches. Objective: To evaluate the feasibility and surgical outcomes of a superciliary keyhole approach for unruptured intracranial aneurysms (UIAs) as an alternative to a pterional approach. Methods: The authors report on a consecutive series of patients who underwent a superciliary approach for clipping UIAs smaller than 15 mm arising at the supraclinoid internal carotid artery (ICA), A1 segment, anterior communicating artery (ACoA), and M1 segment including the middle cerebral artery (MCA) bifurcation. The data were compared with a historical control group (n = 90) who underwent a pterional approach for UIAs. Results: A total of 120 aneurysms were successfully clipped in 102 patients with a mean age of 58 years. There was no direct mortality related to the surgery, and only 1 (1.0%) patient developed significant morbidity adversely affecting the Glasgow Outcome Scale score. The superciliary approach demonstrated statistically significant advantages over the pterional approach, including a shorter operative duration (mean, 120 min), no intraoperative blood transfusion, and extremely rare postoperative epidural hemorrhages. In addition, temporalis atrophy was rare and palsy of the frontalis persisting more than 6 months only occurred in 6 patients (5.9%) and was resolved within 2 years. The overall cosmetic outcome was excellent. Conclusion: A superciliary approach can be a reasonable alternative to a pterional approach for small (&lt;15 mm) UIAs arising at the supraclinoid ICA, A1, ACoA, and M1 segment including the MCA bifurcation.

Early and late results of intracranial direct surgery of anterior communicating artery aneurysms

1979 ◽  
Vol 50 (4) ◽  
pp. 433-440 ◽  
Author(s):  
Shigeaki Hori ◽  
Jiro Suzuki
Keyword(s):  
Operative Mortality ◽  
Artery Aneurysm ◽  
Late Results ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Unruptured Aneurysms ◽  
Accurate Treatment ◽  
Intracranial Operation

✓ During the 14-year period up to September, 1975, 346 patients with a single anterior communicating artery aneurysm, including eight with unruptured aneurysms, were operated on by direct intracranial procedures. There was an early operative mortality of 5.5%. Follow-up studies, an average of 3 years 11 months after surgery, revealed that about 85% of the survivors, excluding those who could not be followed, had regained their working capacity, and that the late mortality and morbidity rates were 9.6% and 2.0%, respectively. The rationale for performing the intracranial operation and factors influencing postoperative results are discussed, with particular emphasis on the techniques for accurate treatment of aneurysms that help to prevent postoperative rebleeding and therefore give better overall surgical results.

scholarly journals The Medina Embolic Device: early clinical experience from a single center

2016 ◽  
Vol 9 (1) ◽  
pp. 77-87 ◽  
Author(s):  
Marta Aguilar Perez ◽  
Pervinder Bhogal ◽  
Rosa Martinez Moreno ◽  
Hansjörg Bäzner ◽  
Oliver Ganslandt ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Clinical Status ◽  
Anterior Communicating Artery ◽  
Major Step ◽  
Unruptured Aneurysms ◽  
True Value ◽  
Unruptured Intracranial Aneurysms ◽  
Flow Diverters

ObjectiveTo report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices.Methods15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices.ResultsThe MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant.ConclusionsThe MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion.

scholarly journals Characteristics of Unruptured Compared to Ruptured Intracranial Aneurysms: A Multicenter Case–Control Study

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Isabel C Hostettler ◽  
Varinder S Alg ◽  
Nichole Shahi ◽  
Fatima Jichi ◽  
Stephen Bonner ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Anterior Communicating Artery ◽  
Imaging Data ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Multivariable Analyses ◽  
Different Characteristics

Abstract BACKGROUND Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression. RESULTS A total of 2334 patients (1729 with aneurysmal subarachnoid hemorrhage, 605 with unruptured aneurysms) were included (mean age 54.22 yr). In multivariable analyses, the following variables were independently associated with rupture status: black ethnicity (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.29-4.56, compared to white) and aneurysm location (anterior cerebral artery/anterior communicating artery [OR 3.21; 95% CI 2.34-4.40], posterior communicating artery [OR 3.92; 95% CI 2.67-5.74], or posterior circulation [OR 3.12; 95% CI 2.08-4.70], compared to middle cerebral artery). The following variables were inversely associated with rupture status: antihypertensive medication (OR 0.65; 95% CI 0.49-0.84), hypercholesterolemia (0.64 OR; 95% CI 0.48-0.85), aspirin use (OR 0.28; 95% CI 0.20-0.40), internal carotid artery location (OR 0.53; 95% CI 0.38-0.75), and aneurysm size (per mm increase; OR 0.76; 95% CI 0.69-0.84). CONCLUSION We show substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms.

Bypass Surgery for Complex Intracranial Aneurysms: 15 Years of Experience at a Single Institution and Review of Pertinent Literature

2017 ◽  
Vol 13 (6) ◽  
pp. 679-688 ◽  
Author(s):  
Seung Pil Ban ◽  
Won-Sang Cho ◽  
Jeong Eun Kim ◽  
Chang Hyeun Kim ◽  
Jae Seung Bang ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Bypass Surgery ◽  
Graft Patency ◽  
Good Alternative ◽  
Karnofsky Performance Scale ◽  
Unruptured Aneurysms ◽  
Maximal Diameter ◽  
Common Location ◽  
The Mean

Abstract BACKGROUND Bypass surgery is a treatment option for complex intracranial aneurysms. OBJECTIVE To determine the utility of bypass surgery for the treatment of complex intracranial aneurysms and to review the literature on this topic. METHODS Sixty-two patients were included in this retrospective study. Unruptured aneurysms were dominant (80.6%), and the internal carotid artery was the most common location of the aneurysm (56.4%), followed by the middle cerebral artery (21.0%). The mean maximal diameter of the aneurysms was 20.5 ± 11.4 mm. The clinical and angiographic states were evaluated preoperatively, immediately after surgery (within 3 days) and at the last follow-up. The mean angiographic and clinical follow-up duration was 34.2 ± 38.9 and 46.5 ± 42.5 months, respectively. RESULTS Sixty-one patients (98.3%) underwent extracranial–intracranial bypass, and 1 underwent intracranial–intracranial bypass. At the last follow-up angiography, 58 aneurysms (93.5%) were completely obliterated and 4 were incompletely obliterated, with a graft patency of 90.3%. Surgical mortality was 0 and permanent morbidity was 8.1%. A good clinical outcome (Karnofsky Performance Scale ≥ 70 and modified Rankin Scale score ≤ 2) was achieved in 91.9% of patients (n = 57). CONCLUSION With a proper selection of bypass type, bypass-associated treatment can be a good alternative for patients with complex intracranial aneurysms when conventional microsurgical clipping or endovascular intervention is not feasible.

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