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Anatomy and morphology of giant aneurysms—angiographic study of 125 consecutive cases

  • Clinical Article - Vascular
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Abstract

Background

Giant intracranial aneurysms are rare and heterogeneous lesions with complex vascular anatomy. The aim of this retrospective study was to provide a comprehensive description of the anatomical features of giant aneurysms.

Methods

We identified 125 patients with 129 giant aneurysms (≥25 mm) who were treated between 1987 and 2007 at the Department of Neurosurgery of Helsinki University Central Hospital (HUCH). All the imaging studies and medical records were reviewed for relevant information.

Results

The distribution of the giant aneurysms among regions was as follows: internal carotid artery (ICA) 39 %, middle cerebral artery (MCA) 32 %, vertebrobasilar and posterior cerebral artery (VB-PCA) region 25 %, and anterior cerebral artery (ACA) including the anterior communicating artery 5 %. The cavernous ICA segment (n = 21, 16 %) and the MCA bifurcation (n = 25, 19 %) were the most frequent specific locations. Half (n = 11) of all fusiform aneurysms were found in the VB-PCA region. As many as 41 % of the giant MCA aneurysms were ruptured. Major anatomic variations were found in three (2 %) and multiple giant aneurysms in three (2 %) patients. Wall calcification was noted in 24 % and intraluminal thrombosis in 33 % of ruptured giant aneurysms (n = 42).

Conclusions

The majority of giant aneurysms are located in the ICA and MCA regions, while the ACA region is an exceptional site. The MCA region is the most common site for ruptured giant aneurysms. Associated anatomic variations and the multiplicity of giant aneurysms are a rare finding.

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Abbreviations

A2–A5 :

A2–A5 segments of anterior cerebral artery

ACA :

anterior cerebral artery

Acom :

anterior communicating artery

C1 :

cervical segment of the internal carotid artery

C4 :

cavernous segment of the internal carotid artery

C6 :

ophthalmic segment of the internal carotid artery

C7 :

communicating segment of the internal carotid artery

CT :

computer tomography

CT angiography :

computed tomography angiography

DSA :

digital subtraction angiography

HUCH :

Helsinki University Central Hospital

ICA :

internal carotid artery

M1 :

M1 segment of middle cerebral artery

MCA :

middle cerebral artery

MR angiography :

magnetic resonance angiography

MRI :

magnetic resonance imaging

PACS :

Picture Archiving and Communicating System

PCA :

posterior cerebral artery

Pcom :

posterior communicating artery

SAH :

subarachnoid hemorrhage

VB :

vertebrobasilar

VB-PCA :

vertebrobasilar and posterior cerebral artery region

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None.

Financial disclosure

The authors of this study have no relevant financial or nonfinancial relationships to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland

    Ville Nurminen, Martin Lehecka, Amit Chakrabarty, Riku Kivisaari, Hanna Lehto, Mika Niemelä & Juha Hernesniemi

  2. Barala Hospital and Research Centre, Jaipur, India

    Amit Chakrabarty

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  1. Ville Nurminen
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  2. Martin Lehecka
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  3. Amit Chakrabarty
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  4. Riku Kivisaari
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  5. Hanna Lehto
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  6. Mika Niemelä
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  7. Juha Hernesniemi
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Correspondence to Ville Nurminen.

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Nurminen, V., Lehecka, M., Chakrabarty, A. et al. Anatomy and morphology of giant aneurysms—angiographic study of 125 consecutive cases. Acta Neurochir 156, 1–10 (2014). https://doi.org/10.1007/s00701-013-1933-4

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  • DOI: https://doi.org/10.1007/s00701-013-1933-4

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