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Differences in anatomical distribution, gender, and sidedness between ruptured and unruptured intracranial aneurysms in a defined patient population

  • Clinical Article
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Abstract

Background

Working with patients with intracranial aneurysms, we have developed a clinical suspicion that there may be differences in the rupture rate of aneurysms depending on the aneurysm’s anatomical location. The aim of the study was to examine the anatomical distribution of ruptured and unruptured intracranial aneurysms in a defined population.

Method

We retrospectively included all patients with an aneurysm treated in our institution between 1 January 1990 and 31 December 1999, and collected the relevant data from the individual patient files. With the Koivisto categories for aneurysm location, we gathered the aneurysms into four categories: ACA, MCA, ICA, and VBA.

Findings

Four hundred forty-four aneurysms were included in the study: 361 in SAH patients and 83 in patients without SAH. ACA aneurysms were over-represented in the ruptured group (36.0% vs. 9.6%, p < 0.0001). MCA aneurysms were more frequent in the unruptured group (51.8% vs. 29.6%, p < 0.0002). Ruptured ACA aneurysms were over-represented among males (p < 0.0001), whereas ruptured ICA aneurysms were more frequent among females (p < 0.0001). Ruptured aneurysms in the posterior circulation were more frequently found on the left side (p < 0.0001).

Conclusion

This study shows that the anatomical distribution of aneurysms is different in SAH patients compared with patients with unruptured aneurysms. Haemodynamic features of the vessel of origin may explain the differences we have found. Furthermore, this study suggests that it is of particular importance to treat patients with incidentally found ACA aneurysms.

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Authors and Affiliations

  1. Section for Neurosurgery, Department of Surgical Sciences, University of Bergen, Bergen, NO-5021, Norway

    Mads Aarhus, Christian A. Helland & Knut Wester

  2. Department of Neurosurgery, Haukeland University Hospital, Bergen, NO-5021, Norway

    Mads Aarhus, Christian A. Helland & Knut Wester

Authors
  1. Mads Aarhus
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  2. Christian A. Helland
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  3. Knut Wester
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Corresponding author

Correspondence to Mads Aarhus.

Additional information

Comment

In this population based study, the authors try to analyze the characteristics of a ruptured aneurysm based on a retrospective analysis of 444 aneurysms in 421 aneurysms, looking specifically at the gender, location and sidedness. Follow-up data on the unruptured aneurysms have not been analyzed and hence the natural history is unavailable.

In this well-written article, apart from giving us a good demographic profile of ruptured aneurysms in a defined population, most of the findings are in consonance with available data [1, 2]. The tendency for even small aneurysms in the anterior cerebral artery location to bleed has been described [3, 4]. One possibly unique finding of unknown significance was the left-sided preponderance for ruptured posterior circulation aneurysms.

The authors conclusion that young males with anterior cerebral artery aneurysms need to be treated aggressively is justified.

References:

1. Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg. 2000 Sep;93(3):379–87.

2. Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ . Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke. 2007 Apr;38(4):1404–10.

3. Forget TR Jr, Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, Rosenwasser RH. A review of size and location of ruptured intracranial aneurysms. Neurosurgery. 2001 Dec;49(6):1322–5

4. Castro MA, Putman CM, Sheridan MJ, Cebral JR. Hemodynamic patterns of anterior communicating artery aneurysms: A possible association with rupture. AJNR Am J Neuroradiol. 2009 Jan 8(Epub).

R. Kariyattil

Kerala, India

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Aarhus, M., Helland, C.A. & Wester, K. Differences in anatomical distribution, gender, and sidedness between ruptured and unruptured intracranial aneurysms in a defined patient population. Acta Neurochir 151, 1569–1574 (2009). https://doi.org/10.1007/s00701-009-0316-3

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  • DOI: https://doi.org/10.1007/s00701-009-0316-3

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