Abstract
Background
Intracranial aneurysms (IA) are usually quantified according to their largest diameter. However, volumetry has recently been increasingly conducted as well, especially in giant intracranial aneurysms (GIAs). Since so far the true value of GIA volumetry is unknown, we designed a trial to examine correlations between GIA diameter and volume with special focus on clinical implications.
Methods
Magnetic resonance imaging of 69 unruptured GIAs in 66 patients was retrospectively evaluated. The largest diameter and volume were measured. Also, potential associations to the patients’ clinical conditions were examined.
Results
Comparing GIA sizes of our patient cohort produced different results depending on whether GIA diameter or volume was measured. Measuring the diameter identified posterior circulation GIAs as the largest ones (39.2 mm, IQR 37.3–48.3), while measuring the volume found GIAs of the MCA to be the largest ones (12.3 cm3, IQR 7.2–27.8). A correlation of GIA diameter and volume was only found in anterior circulation GIAs, which were predominantly saccular in shape, but not in those of the posterior circulation, of which most were fusiform. Neither GIA diameter nor GIA volume but only GIA location was associated with neurological deficits.
Conclusion
Diameter and volume measurements are not interchangeable modes of GIA quantification. Our data suggest that the idea of distinguishing different sizes of GIA may be clinically less relevant than examining their location, shape or mass effect.
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Acknowledgments
The Giant Intracranial Aneurysm Registry is funded by the Center for Stroke Research-Berlin. The grant number is “CS-2009-12”
Clinical Trial Registration-URL:
http://www.clinicaltrials.gov. Unique identifier: NCT02066493.
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Comment
This is a concise report on analyses of 2D diametric and volumetric measurement of intracranial giant aneurysms and their correlation with patients’ symptoms. Although this study does not alter in any way or shape the clinical management of those complex aneurysms, it shows the discrepancy between size and volume in posterior circulation giant aneurysms (most likely due to more fusiform shape) and the fact that location but not the size or volume is the only indicator of symptomatic aneurysms in this population.
Amir Dehdashti
NY,USA
No parts of this project have been presented anywhere before.
The Giant Aneurysm Study Group (November 2014)
The Giant Aneurysm Study Group (November 2014)
Vajkoczy P, Uebelacker A, Maldaner N, Dengler J
Department of Neurosurgery, Charité – Universitaetsmedizin Berlin
Endres M
Department of Neurology, Charité – Universitaetsmedizin Berlin
Bohner G, Wiener E, Bauknecht HC
Department of Neuroradiology, Charité – Universitaetsmedizin Berlin
Heuschmann PU, Malzahn U
Institute of Clinical Epidemiology and Biometry, University of Würzburg
Glaesker S, Zentner J, Van Velthoven V
Department of Neurosurgery, University Hospital Freiburg, Germany
Guhl S, Schroeder HWS
Department of Neurosurgery, University of Greifswald, Germany
Strowitzki M
Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany
Etminan N, Haengghi D, Eicker S, Turowski B
Department of Neurosurgery, University of Düsseldorf, Germany
Schebesch KM, Brawanski A
Department of Neurosurgery, University of Regensburg, Germany
Wrede K, Sure U
Department of Neurosurgery, University of Essen, Germany
Schmidt NO, Regelsberger J, Westphal M
Department of Neurosurgery, University Medical Center, Hamburg Eppendorf, Germany
Mielke D, Rohde V
Department of Neurosurgery, Georg-August-University Goettingen, Germany
Hosch H, Moskopp D
Department of Neurosurgery Vivantes-Klinikum im Friedrichshain, Berlin, Germany
Joedicke A
Department of Neurosurgery Vivantes-Klinikum Neukoelln, Berlin, Germany
Hohaus C, Meisel HJ
Department of Neurosurgery, BG-Clinic Bergmannstrost, Halle, Germany.
Wostrack M, Meyer B, Lehmberg J
Department of Neurosurgery, Technical University of Munich, Germany
Musahl C, Hopf N
Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
Winkler G, Spetzger U
Department of Neurosurgery, Klinikum Karlsruhe, Germany
Graewe A, Meier U
Department of Neurosurgery, Unfallkrankenhaus Berlin, Germany
Hong B, Nakamura M, Krauss J
Department of Neurosurgery, Hannover Medical School, Hannover, Germany
Grote A, Simon M, Schramm J
Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
Kursumovic A, Rath SA
Department of Neurosurgery and Interventional Neuroradiology, Donau-Isar-Klinikum,
Deggendorf, Germany
Walter J, Kalff R
Department of Neurosurgery, Friedrich-Schiller-University, Jena, Germany
Marbacher S, Fathi A, Fandino J
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland,
Familiari P, Raco A
Department of Neurosurgery, University of Rome “Sapienza”, Rome, Italy
Bijlenga P, Schaller K
Service de Neurochirurgie, Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève, Switzerland
Gruber A, Wang WT, Knosp E
Department of Neurosurgery, Medical University Vienna, Vienna, Austria
Hoffmann KT, Boxhammer E
Department of Neuroradiology, University of Leipzig, Leipzig, Germany
Rüfenacht DA
Department of Neuroradiology, Klinik Hirslanden, Zurich, Switzerland
Boccardi E, Piano M
Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Milano, Italy
Niemelä M, Nurminen V, Lehecka M, Hernesniemi J
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
Burkhardt JK, Bozinov O, Regli L
Department of Neurosurgery, University Hospital of Zurich, Switzerland
Shekhtman OD, Eliava SS
Burdenko Neurosurgical Institute, Russian Academy of Medical Sciences, Moscow, Russia
Kato N, Irie K, Nishimura K, Kaku S, Arakawa H, Yuki I, Ishibashi T, Murayama Y
Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
Fiss I, Kombos T
Department of Spine Surgery and Neurosurgery, Helios Klinikum Hildesheim, Hildesheim, Germany
van der Zwan A, van Doormaal TP
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
Cognard C, Gawlitza M
Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
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Dengler, J., Maldaner, N., Bijlenga, P. et al. Quantifying unruptured giant intracranial aneurysms by measuring diameter and volume—a comparative analysis of 69 cases. Acta Neurochir 157, 361–368 (2015). https://doi.org/10.1007/s00701-014-2292-5
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DOI: https://doi.org/10.1007/s00701-014-2292-5