Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Neurosurg. 2012 Nov;117(5):913-9. doi: 10.3171/2012.7.JNS111766. Epub 2012 Sep 7.
Management of unruptured intracranial aneurysms remains controversial in neurosurgery. The contribution of morphological parameters has not been included in the treatment paradigm in a systematic manner or for any particular aneurysm location. The authors present a large sample of middle cerebral artery (MCA) aneurysms that were assessed using morphological variables to determine the parameters associated with aneurysm rupture.
Preoperative CT angiography (CTA) studies were evaluated using Slicer software to generate 3D models of the aneurysms and their surrounding vascular architecture. Morphological parameters examined in each model included 5 variables already defined in the literature (aneurysm size, aspect ratio, aneurysm angle, vessel angle, and size ratio) and 3 novel variables (flow angle, distance to the genu, and parent-daughter angle). Univariate and multivariate statistical analyses were performed to determine statistical significance.
Between 2005 and 2008, 132 MCA aneurysms were treated at a single institution, and CTA studies of 79 aneurysms (40 ruptured and 39 unruptured) were analyzed. Fifty-three aneurysms were excluded because of reoperation (4), associated AVM (2), or lack of preoperative CTA studies (47). Ruptured aneurysms were associated with larger size, greater aspect ratio, larger aneurysm and flow angles, and smaller parent-daughter angle. Multivariate logistic regression revealed that aspect ratio, flow angle, and parent-daughter angle were the strongest factors associated with ruptured aneurysms.
Aspect ratio, flow angle, and parent-daughter angle are more strongly associated with ruptured MCA aneurysms than size. The association of parameters independent of aneurysm morphology with ruptured aneurysms suggests that these parameters may be associated with an increased risk of aneurysm rupture. These factors are readily applied in clinical practice and should be considered in addition to aneurysm size when assessing the risk of aneurysm rupture specific to the MCA location.
在神经外科学中，未破裂颅内动脉瘤的处理仍然存在争议。形态参数的作用尚未系统地纳入治疗模式，也未纳入任何特定的动脉瘤位置。作者报告了大量大脑中动脉（MCA）动脉瘤的样本，这些动脉瘤使用形态学变量进行了评估，以确定与动脉瘤破裂相关的参数。
使用 Slicer 软件对术前 CT 血管造影（CTA）研究进行评估，以生成动脉瘤及其周围血管结构的 3D 模型。在每个模型中检查的形态学参数包括已经在文献中定义的 5 个变量（动脉瘤大小、长宽比、动脉瘤角度、血管角度和大小比）和 3 个新变量（血流角度、距离主干和母-子角度）。进行单变量和多变量统计分析以确定统计学意义。
在 2005 年至 2008 年期间，在一家机构治疗了 132 个 MCA 动脉瘤，分析了 79 个动脉瘤（40 个破裂和 39 个未破裂）的 CTA 研究。53 个动脉瘤因再手术（4 个）、伴发动静脉畸形（AVM）（2 个）或缺乏术前 CTA 研究（47 个）而被排除。破裂的动脉瘤与更大的大小、更大的长宽比、更大的动脉瘤和血流角度以及更小的母-子角度相关。多变量逻辑回归显示，长宽比、血流角度和母-子角度是与破裂动脉瘤最相关的因素。
与大小相比，长宽比、血流角度和母-子角度与 MCA 破裂动脉瘤的相关性更强。与动脉瘤形态无关的参数与破裂动脉瘤的相关性表明，这些参数可能与动脉瘤破裂的风险增加有关。这些因素在临床实践中易于应用，在评估 MCA 位置特定的动脉瘤破裂风险时，应考虑除动脉瘤大小以外的这些因素。
