Advertisement

Association of Morphologic and Demographic Features of Intracranial Aneurysms with Their Rupture: A Retrospective Analysis

Chapter
First Online:
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 115)

Abstract

Background: In spite of its common occurrence, the factors predictive of the rupture of intracranial aneurysms (IAs) remain poorly defined.

Method: A retrospective analysis of patients admitted with a primary diagnosis of cerebral aneurysm in a single institution was done. The factors studied were age, sex, size, site, side, multiplicity, neck type, aspect ratio, positive family history, smoking and drinking habits, and hypertension. The morphological parameters were evaluated for a total of 5,138 aneurysms obtained from the 2,347 patients. Factors found significant on univariate analysis were further tested on a multivariate model.

Findings: We found 1,088 patients (46.36%) had at least a single aneurysmal rupture. Among the morphologic factors, size greater than 10 mm, right sidedness, aspect ratio greater than 1.6, deviated neck type, and multiplicity were found to be associated with higher incidences of rupture. Aneurysms on posterior communicating and middle cerebral arteries were found to be more prone to rupture. The demographic factors that were more linked with the ruptured aneurysms were positive family history, smoking, and hypertension.

Conclusions: Relevant cases should be started on intensive lifestyle modification, and extensive screening of those with a positive family history is highly warranted. All “at-risk” patients should be evaluated for early surgical intervention.

Keywords

Cerebral aneurysms Risk factors Familial cerebral aneurysms Hypertension Smoking 
This is a preview of subscription content, log in to check access.

Notes

Conflicts of Interest Statement

We declare that we have no conflict of interest.

References

  1. 1.
    Beck J, Rohde S, Berkefeld J, Seifert V, Raabe A (2006) Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography. Surg Neurol 65:18–27PubMedCrossRefGoogle Scholar
  2. 2.
    Carter BS, Sheth S, Chang E, Sethl M, Ogilvy CS (2006) Epidemiology of the size distribution of intracranial bifurcation aneurysms: smaller size of distal aneurysms and increasing size of unruptured aneurysms with age. Neurosurgery 58:217–223PubMedCrossRefGoogle Scholar
  3. 3.
    Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM (2005) Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. Am J Neuroradiol 26:2550–2559PubMedGoogle Scholar
  4. 4.
    Clarke G, Mendelow AD, Mitchell P (2005) Predicting the risk of rupture of intracranial aneurysms based on anatomical location. Acta Neurochir (Wien) 147:259–263CrossRefGoogle Scholar
  5. 5.
    Clarke M (2008) Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology 50:653–664PubMedCrossRefGoogle Scholar
  6. 6.
    Dhar S, Tremmel M, Mocco J, Kim M, Yamamoto J, Siddiqui AH, Hopkins LN, Meng H (2008) Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 63:185–197PubMedCrossRefGoogle Scholar
  7. 7.
    Forget TR Jr, Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, Rosenwasser RH (2001) A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49:1322–1326PubMedCrossRefGoogle Scholar
  8. 8.
    Greenberg MS (2006) Handbook of neurosurgery, 6th edn. Thieme, New York, pp 781–826Google Scholar
  9. 9.
    Hassan T, Timofeev EV, Saito T, Shimizu H, Ezura M, Matsumoto Y, Takayama K, Tominaga T, Takahashi A (2005) A proposed parent vessel geometry-based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture. J Neurosurg 103:662–680PubMedCrossRefGoogle Scholar
  10. 10.
    International Study of Unruptured Intracranial Aneurysms Investigators (1998) Unruptured intracranial aneurysm – risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733CrossRefGoogle Scholar
  11. 11.
    Juvela S, Hillbom M, Numminen H, Koskinen P (1993) Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage. Stroke 24:639–646PubMedCrossRefGoogle Scholar
  12. 12.
    Juvela S, Porras M, Poussa K (2000) Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 93:379–387PubMedCrossRefGoogle Scholar
  13. 13.
    Lai HP, Cheng KM, Yu SCH, Yeung KMA, Cheung YL, Chan CM, Poon WS, Lui WM (2009) Size, location, and multiplicity of ruptured intracranial aneurysms in the Hong Kong Chinese population with subarachnoid haemorrhage. Hong Kong Med J 15:262–266PubMedGoogle Scholar
  14. 14.
    Lee JS, Park IS et al (2008) Familial intracranial aneurysms. J Korean Neurosurg Soc 44:136–140PubMedCrossRefGoogle Scholar
  15. 15.
    Lindner SH, Bor ASE, Rinkel GJE (2010) Differences in risk factors according to the site of intracranial aneurysms. J Neurol Neurosurg Psychiatry 81:116–118PubMedCrossRefGoogle Scholar
  16. 16.
    Nahed BV, DiLuna ML et al (2005) Hypertension, age and location predict rupture of small intracranial aneurysms. Neurosurgery 57:676–683PubMedCrossRefGoogle Scholar
  17. 17.
    Orz Y, Kobayashi S, Osawa M, Tanaka Y (1997) Aneurysm size: a prognostic factor for rupture. Br J Neurosurg 11:144–149PubMedCrossRefGoogle Scholar
  18. 18.
    Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256PubMedCrossRefGoogle Scholar
  19. 19.
    Tremmel M, Dhar S, Levy EI et al (2009) Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implications for rupture: results from a virtual experimental study. Neurosurgery 64:622–631PubMedCrossRefGoogle Scholar
  20. 20.
    Ujiie H, Sato K, Onda H, Oikawa A, Kagawa M, Takakura K, Kobayashi N (1993) Clinical analysis of incidentally discovered unruptured aneurysms. Stroke 24:1850–1856PubMedCrossRefGoogle Scholar
  21. 21.
    Ujiie H, Tamano Y, Sasaki K, Hori T (2001) Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery 48:495–503PubMedCrossRefGoogle Scholar
  22. 22.
    Weir B, Disney L, Karrison T (2002) Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 96:64–70PubMedCrossRefGoogle Scholar
  23. 23.
    Weir B, Amidei C, Kongable G, Findlay JM, Kassell NF, Kelly J, Dai L, Karrison TG (2003) The aspect ratio (dome/neck) of ruptured and unruptured aneurysms. J Neurosurg 99:447–451PubMedCrossRefGoogle Scholar
  24. 24.
    Wiebers DO, Whisnant JP, Huston J et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Department of Neurological SurgeryThomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations

Cite chapter

Buy options