, Volume 57, Issue 1, pp 35–40 | Cite as

Clinical characteristics and preferential location of intracranial mirror aneurysms: a comparison with non-mirror multiple and single aneurysms

  • Young-Jun Lee
  • Tiago Parreira
  • Charles C. Matouk
  • Ravi Menezes
  • Daniel M. Mandell
  • Karel G. terBrugge
  • Robert A. Willinsky
  • Timo KringsEmail author
Interventional Neuroradiology



The purpose of our study was to compare the clinical characteristics and preferential localization of aneurysms in three patient groups: single aneurysm, non-mirror multiple aneurysms, and mirror aneurysms.


We retrospectively reviewed the clinical and radiological data of 2223 consecutive patients harboring 3068 aneurysms registered at the Toronto Western Hospital between May 1994 and November 2010. The patients were divided into single, non-mirror multiple, or mirror aneurysm groups. Expected incidences of mirror aneurysms at each location were calculated on the basis of the single aneurysm incidences at each location.


Patients with mirror aneurysms (n = 197) did not differ from patients with non-mirror multiple aneurysms (n = 392) in having female predominance (81.7 vs. 76.3 %) or a family history of intracranial aneurysm (20.5 vs. 17.6 %). When compared with expected incidences at each location, mirror aneurysms were more frequently found at the cavernous internal carotid artery (30 vs. 11.5 %) (p < 0.0001). Mirror aneurysms involving the posterior circulation were less frequent (6.7 %) than aneurysms in the single (19.6 %) or non-mirror multiple aneurysm groups (18.9 %) (p < 0.05).


Patients with mirror aneurysms had similar clinical characteristics to non-mirror multiple aneurysm patients. Mirror aneurysms showed a predilection for the cavernous carotid artery, whereas they were comparatively rare in the posterior circulation.


Aneurysm Intracranial aneurysm Mirror aneurysm Multiple aneurysm 





Anterior cerebral artery


Anterior communicating artery


Middle cerebral artery


Internal carotid artery


Anterior choroidal artery


Posterior communicating artery

cavernous ICA

ICA below the origin of PComA


Posterior cerebral artery


Basilar artery


Superior cerebellar artery


Anterior inferior cerebellar artery


Posterior inferior cerebellar artery


Vertebral artery



The authors thank the members of the Toronto Vascular Malformation Study Group for many fruitful discussions and critical review of the manuscript.

Ethical Standards and Patient Consent

We declare that all human and animal studies have been approved by our local review board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study

Conflict of Interest

We declare that we have no conflict of interest.


  1. 1.
    Inagawa T (2009) Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan. Acta Neurochir (Wien) 151:1623–1630CrossRefGoogle Scholar
  2. 2.
    Juvela S (2000) Risk factors for multiple intracranial aneurysms. Stroke 31:392–397PubMedCrossRefGoogle Scholar
  3. 3.
    Ostergaard JR, Hog E (1985) Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 63:49–55PubMedCrossRefGoogle Scholar
  4. 4.
    Pierot L, Boulin A, Castaings L, Rey A, Moret J (1997) The endovascular approach in the management of patients with multiple intracranial aneurysms. Neuroradiology 39:361–366PubMedCrossRefGoogle Scholar
  5. 5.
    Porter PJ, Mazighi M, Rodesch G et al (2001) Endovascular and surgical management of multiple intradural aneurysms. Review of 122 patients managed between 1993 and 1999. Interv Neuroradiol 7:291–302PubMedCentralPubMedGoogle Scholar
  6. 6.
    Qureshi AI, Suarez JI, Parekh PD et al (1998) Risk factors for multiple intracranial aneurysms. Neurosurgery 43:22–26, discussion 26-27PubMedCrossRefGoogle Scholar
  7. 7.
    Rinne J, Hernesniemi J, Puranen M, Saari T (1994) Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 35:803–808PubMedCrossRefGoogle Scholar
  8. 8.
    Meissner I, Torner J, Huston J 3rd et al (2012) Mirror aneurysms: a reflection on natural history. J Neurosurg 116:1238–1241PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Macdonald RL (2012) Mirror aneurysms. J Neurosurg 116:1235–1236, discussion 1236-1237PubMedCrossRefGoogle Scholar
  10. 10.
    Ellamushi HE, Grieve JP, Jager HR, Kitchen ND (2001) Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg 94:728–732PubMedCrossRefGoogle Scholar
  11. 11.
    Casimiro MV, McEvoy AW, Watkins LD, Kitchen ND (2004) A comparison of risk factors in the etiology of mirror and nonmirror multiple intracranial aneurysms. Surg Neurol 61:541–545PubMedCrossRefGoogle Scholar
  12. 12.
    Campos C, Churojana A, Rodesch G, Alvarez H, Lasjaunias P (1998) Multiple intracranial arterial aneurysms: a congenital metameric disease? Review of 113 consecutive patients with 280 AA. Interv Neuroradiol 4:293–299PubMedGoogle Scholar
  13. 13.
    Rinne J, Hernesniemi J, Niskanen M, Vapalahti M (1995) Management outcome for multiple intracranial aneurysms. Neurosurgery 36:31–37, discussion 37-38PubMedCrossRefGoogle Scholar
  14. 14.
    Investigators UJ, Morita A, Kirino T et al (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366:2474–2482CrossRefGoogle Scholar
  15. 15.
    Lu HT, Tan HQ, Gu BX, Wu W, Li MH (2013) Risk factors for multiple intracranial aneurysms rupture: a retrospective study. Clin Neurol Neurosurg 115:690–694PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Young-Jun Lee
    • 1
    • 2
  • Tiago Parreira
    • 3
  • Charles C. Matouk
    • 4
  • Ravi Menezes
    • 1
  • Daniel M. Mandell
    • 1
  • Karel G. terBrugge
    • 1
  • Robert A. Willinsky
    • 1
  • Timo Krings
    • 1
    • 5
    Email author
  1. 1.Division of Neuroradiology, Department of Medical Imaging, Toronto Western HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of RadiologyHanyang University Hospital, Hanyang University College of MedicineSeoulSouth Korea
  3. 3.Hospitais da Universidade de CoimbraCoimbraPortugal
  4. 4.Departments of Neurosurgery & Diagnostic Radiology, Neurovascular & Stroke ProgramsYale University School of MedicineNew HavenUSA
  5. 5.Division of Neurosurgery, Toronto Western HospitalUniversity of TorontoTorontoCanada

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