Skip to main content

Advertisement

SpringerLink
Log in

Angiographic characteristics of ruptured paraclinoid aneurysms: risk factors for rupture

  • Clinical Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The diagnosis and treatment of unruptured paraclinoid aneurysms has been increasing with the recent advent of diagnostic tools and less invasive endovascular therapeutic options. Considering the low incidence of rupture, investigation of the characteristics of ruptured paraclinoid aneurysm is important to predict rupture risk of the paraclinoid aneurysms. The objective of this study is to evaluate probable factors for rupture by analyzing the characteristics of ruptured paraclinoid aneurysms.

Methods

A total of 2,276 aneurysms (1,419 ruptured and 857 unruptured) were diagnosed and treated endovascularly or microsurgically between 2001 and 2011. Among them, 265 were paraclinoid aneurysms, of which 37 were ruptured. Removing 12 blister-like aneurysms, 25 ruptured and 228 unruptured saccular aneurysms were included and the medical records and radiological images were retrospectively analyzed.

Results

Of 25 aneurysms, 16 (64.0 %) were located in the superior direction. Five were inferior located lesions (20 %) and four were medially located lesions (16.0 %). Laterally located lesions were not found. The mean size of aneurysms was 9.4 ± 5.6 mm. Ten aneurysms (40.0 %) were ≥ 10 mm in size. Thirteen aneurysms (52.0 %) were lobulated. The superiorly located aneurysms were larger than the other aneurysms (10.3 ± 5.8 mm vs. 7.7 ± 4.9 mm) and more frequently lobulated (ten of 16 vs. three of nine). In a comparative analysis, the ruptured aneurysms were located more in the superior direction compared with unruptured aneurysms (64 vs. 23.2 %, p < 0.0001). Large aneurysms (36.0 vs. 7.9 %, p < 0.0001), longer fundus diameter (mean 9.4 ± 5.6 vs. 4.8 ± 3.3 mm, p = 0.001), dome-to-neck ratio (mean 1.8 ± 0.9 vs. 1.2 ± 0.5, p < 0.0001), and lobulated shape aneurysms were more likely to be ruptured aneurysms (13 of 25 ruptured aneurysms, 52.0 %, p = 0.001).

Conclusions

Rupture risk of the paraclinoid aneurysm is very low. However, superiorly located paraclinoid aneurysms appear more likely to rupture than other locations. Angiographically, more conservative indication for the treatment of paraclinoid aneurysm should be recommended except for superior located lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abe M, Tabuchi K, Yokoyama H, Uchino A (1998) Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89:419–424

    Article  PubMed  CAS  Google Scholar 

  2. Arnautovic KI, Al-Mefty O, Angtuaco E (1998) A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms. Surg Neurol 50:504–518, discussion 518–520

    Article  PubMed  CAS  Google Scholar 

  3. Beck J, Rohde S, el Beltagy M, Zimmermann M, Berkefeld J, Seifert V, Raabe A (2003) Difference in configuration of ruptured and unruptured intracranial aneurysms determined by biplanar digital subtraction angiography. Acta Neurochir (Wien) 145:861–865, discussion 865

    Article  CAS  Google Scholar 

  4. Beretta F, Andaluz N, Zuccarello M (2004) Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: treatment options and strategies based on a clinical series. J Neurosurg Sci 48:149–156

    PubMed  CAS  Google Scholar 

  5. Boet R, Wong GK, Poon WS, Lam JM, Yu SC (2005) Aneurysm recurrence after treatment of paraclinoid/ophthalmic segment aneurysms–a treatment-modality assessment. Acta Neurochir (Wien) 147:611–616, discussion 616

    Article  CAS  Google Scholar 

  6. Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A (1999) Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30:470–476

    Article  PubMed  CAS  Google Scholar 

  7. Cawley CM, Zipfel GJ, Day AL (1998) Surgical treatment of paraclinoid and ophthalmic aneurysms. Neurosurg Clin N Am 9:765–783

    PubMed  CAS  Google Scholar 

  8. D’Urso PI, Karadeli HH, Kallmes DF, Cloft HJ, Lanzino G (2012) Coiling for paraclinoid aneurysms: time to make way for flow diverters? AJNR Am J Neuroradiol 33:1470–1474

    Article  PubMed  Google Scholar 

  9. Day AL (1990) Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:677–691

    Article  PubMed  CAS  Google Scholar 

  10. de Oliveira JG, Borba LA, Rassi-Neto A, de Moura SM, Sanchez-Junior SL, Rassi MS, de Holanda CV, Giudicissi-Filho M (2009) Intracranial aneurysms presenting with mass effect over the anterior optic pathways: neurosurgical management and outcomes. Neurosurg Focus 26:E3

    Article  PubMed  Google Scholar 

  11. 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 63:185–196, discussion 196–187

    Article  PubMed  Google Scholar 

  12. Diraz A, Kyoshima K, Kobayashi S (1993) Dorsal internal carotid artery aneurysm: classification, pathogenesis, and surgical considerations. Neurosurg Rev 16:197–204

    Article  PubMed  CAS  Google Scholar 

  13. Drake CG, Vanderlinden RG, Amacher AL (1968) Carotid-ophthalmic aneurysms. J Neurosurg 29:24–31

    Article  PubMed  CAS  Google Scholar 

  14. Ferguson GG, Drake CG (1980) Carotid-ophthalmic aneurysms: the surgical management of those cases presenting with compression of the optic nerves and chiasm alone. Clin Neurosurg 27:263–307

    PubMed  CAS  Google Scholar 

  15. Fulkerson DH, Horner TG, Payner TD, Leipzig TJ, Scott JA, DeNardo AJ, Redelman K, Goodman JM (2009) Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: a 16-year experience of a combined neurosurgical and endovascular team. Neurosurgery 64:218–229, discussion 229–230

    Article  PubMed  Google Scholar 

  16. Guidetti B, La Torre E (1975) Management of carotid-ophthalmic aneurysms. J Neurosurg 42:438–442

    Article  PubMed  CAS  Google Scholar 

  17. Heros RC, Nelson PB, Ojemann RG, Crowell RM, DeBrun G (1983) Large and giant paraclinoid aneurysms: surgical techniques, complications, and results. Neurosurgery 12:153–163

    Article  PubMed  CAS  Google Scholar 

  18. Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS (2001) Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 48:78–89, discussion 89–90

    PubMed  CAS  Google Scholar 

  19. Huang MC, Baaj AA, Downes K, Youssef AS, Sauvageau E, van Loveren HR, Agazzi S (2011) Paradoxical trends in the management of unruptured cerebral aneurysms in the United States: analysis of nationwide database over a 10-year period. Stroke 42:1730–1735

    Article  PubMed  Google Scholar 

  20. Iihara K, Murao K, Sakai N, Shindo A, Sakai H, Higashi T, Kogure S, Takahashi JC, Hayashi K, Ishibashi T, Nagata I (2003) Unruptured paraclinoid aneurysms: a management strategy. J Neurosurg 99:241–247

    Article  PubMed  Google Scholar 

  21. International Study of Unruptured Intracranial Aneurysms Investigators (1998) Unruptured intracranial aneurysms–risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733

    Article  Google Scholar 

  22. Jin SC, Kwon do H, Ahn JS, Kwun BD, Song Y, Choi CG (2009) Clinical and radiological outcomes of endovascular detachable coil embolization in paraclinoid aneurysms: a 10-year experience. J Korean Neurosurg Soc 45:5–10

    Article  PubMed  Google Scholar 

  23. Juvela S (2002) Natural history of unruptured intracranial aneurysms: risks for aneurysm formation, growth, and rupture. Acta Neurochir Suppl 82:27–30

    PubMed  CAS  Google Scholar 

  24. Kattner KA, Bailes J, Fukushima T (1998) Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery: report of 29 cases. Surg Neurol 49:471–480

    Article  PubMed  CAS  Google Scholar 

  25. Krisht AF, Hsu SC (2008) Paraclinoid aneurysms. Contemporary Neurosurgery 30:1–6

    Google Scholar 

  26. Lee CC, Hsieh TC, Wang YC, Lo YL, Lee ST, Yang TC (2010) Ruptured symptomatic internal carotid artery dorsal wall aneurysm with rapid configurational change. Clinical experience and management outcome: an original article. Eur J Neurol 17:1277–1284

    Article  PubMed  Google Scholar 

  27. Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6,368 cases in the cooperative study. J Neurosurg 25:219–239

    Article  PubMed  CAS  Google Scholar 

  28. Loumiotis I, D’Urso PI, Tawk R, Cloft HJ, Kallmes DF, Kairouz V, Hanel R, Lanzino G (2012) Endovascular treatment of ruptured paraclinoid aneurysms: results, complications, and follow-up. AJNR Am J Neuroradiol 33:632–637

    Article  PubMed  CAS  Google Scholar 

  29. Meling TR, Sorteberg A, Bakke SJ, Slettebo H, Hernesniemi J, Sorteberg W (2008) Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg 108:662–671

    Article  PubMed  Google Scholar 

  30. Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366:2474–2482

    Article  PubMed  Google Scholar 

  31. Nakagawa F, Kobayashi S, Takemae T, Sugita K (1986) Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 65:303–308

    Article  PubMed  CAS  Google Scholar 

  32. Nguyen TN, Raymond J, Guilbert F, Roy D, Berube MD, Mahmoud M, Weill A (2008) Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture. J Neurosurg 108:1088–1092

    Article  PubMed  Google Scholar 

  33. Ogawa A, Suzuki M, Ogasawara K (2000) Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 47:578–583, discussion 583–576

    PubMed  CAS  Google Scholar 

  34. Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, Kassam A (2005) Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:506–514

    PubMed  Google Scholar 

  35. Park HK, Horowitz M, Jungreis C, Kassam A, Koebbe C, Genevro J, Dutton K, Purdy P (2003) Endovascular treatment of paraclinoid aneurysms: experience with 73 patients. Neurosurgery 53:14–23, discussion 24

    Article  PubMed  Google Scholar 

  36. Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251–256

    Article  PubMed  CAS  Google Scholar 

  37. San Millan Ruiz D, Yilmaz H, Dehdashti AR, Alimenti A, de Tribolet N, Rufenacht DA (2006) The perianeurysmal environment: influence on saccular aneurysm shape and rupture. AJNR Am J Neuroradiol 27:504–512

    PubMed  CAS  Google Scholar 

  38. Sherif C, Gruber A, Dorfer C, Bavinzski G, Standhardt H, Knosp E (2009) Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long-term follow-up of a multidisciplinary management strategy. J Neurol Neurosurg Psychiatry 80:1261–1267

    Article  PubMed  CAS  Google Scholar 

  39. Shigeta H, Kyoshima K, Nakagawa F, Kobayashi S (1992) Dorsal internal carotid artery aneurysms with special reference to angiographic presentation and surgical management. Acta Neurochir (Wien) 119:42–48

    Article  CAS  Google Scholar 

  40. Thornton J, Aletich VA, Debrun GM, Alazzaz A, Misra M, Charbel F, Ausman JI (2000) Endovascular treatment of paraclinoid aneurysms. Surg Neurol 54:288–299

    Article  PubMed  CAS  Google Scholar 

  41. Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F (1999) Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45:119–129, discussion 129–130

    Article  PubMed  CAS  Google Scholar 

  42. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828

    Article  PubMed  CAS  Google Scholar 

  43. Wiebers DO, Piepgras DG, Brown RD Jr, Meissner I, Torner J, Kassell NF, Whisnant JP, Huston J 3rd, Nichols DA (2002) Unruptured aneurysms. J Neurosurg 96:50–51, discussion 58–60

    Article  PubMed  Google Scholar 

  44. Wiebers DO, Whisnant JP, O’Fallon WM (1981) The natural history of unruptured intracranial aneurysms. N Engl J Med 304:696–698

    Article  PubMed  CAS  Google Scholar 

  45. Wiebers DO, Whisnant JP, Sundt TM Jr, O’Fallon WM (1987) The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:23–29

    Article  PubMed  CAS  Google Scholar 

  46. Winn HR, Almaani WS, Berga SL, Jane JA, Richardson AE (1983) The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642–651

    Article  PubMed  CAS  Google Scholar 

  47. Yadla S, Campbell PG, Grobelny B, Jallo J, Gonzalez LF, Rosenwasser RH, Jabbour PM (2011) Open and endovascular treatment of unruptured carotid-ophthalmic aneurysms: clinical and radiographic outcomes. Neurosurgery 68:1434–1443, discussion 1443

    PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Seoul St. Mary’s Hospital, Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, South Korea

    Se-yang Oh, Myeong Jin Kim, Kwan Sung Lee & Yong Sam Shin

  2. Department of Radiology, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea

    Bum-soo Kim

  3. Department of Radiology, Yonsei University, College of Medicine, Severance Hospital, Seoul, Republic of Korea

    Byung Moon Kim

Authors
  1. Se-yang Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myeong Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Byung Moon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kwan Sung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bum-soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yong Sam Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Sam Shin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oh, Sy., Kim, M.J., Kim, B.M. et al. Angiographic characteristics of ruptured paraclinoid aneurysms: risk factors for rupture. Acta Neurochir 155, 1493–1499 (2013). https://doi.org/10.1007/s00701-013-1794-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1794-x

Keywords

Search

Navigation