Shen Yuanyuan, Molenberg Rob, Bokkers Reinoud P H, Wei Yanji, Uyttenboogaart Maarten, van Dijk J Marc C
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
J Pers Med. 2022 Jun 20;12(6):1008. doi: 10.3390/jpm12061008.
The role of regional hemodynamics in the intracranial aneurysmal formation, growth, and rupture has been widely discussed based on numerical models over the past decades. Variation of the circle of Willis (CoW), which results in hemodynamic changes, is associated with the aneurysmal formation and rupture. However, such correlation has not been further clarified yet. The aim of this systematic review is to investigate whether simulated hemodynamic indices of the CoW are relevant to the formation, growth, or rupture of intracranial aneurysm. We conducted a review of MEDLINE, Web of Science, and EMBASE for studies on the correlation between hemodynamics indices of the CoW derived from numerical models and intracranial aneurysm up to December 2020 in compliance with PRISMA guidelines. Three case reports out of 1046 publications met our inclusion and exclusion criteria, reporting 13 aneurysms in six patients. Eleven aneurysms were unruptured, and the state of the other two aneurysms was unknown. Wall shear stress, oscillatory shear index, von-Mises tension, flow velocity, and flow rate were reported as hemodynamic indices. Due to limited cases and significant heterogeneity between study settings, meta-analysis could not be performed. Numerical models can provide comprehensive information on the cerebral blood flow as well as local flow characteristics in the intracranial aneurysm. Based on only three case reports, no firm conclusion can be drawn regarding the correlation between hemodynamic parameters in the CoW derived from numerical models and aneurysmal formation or rupture. Due to the inherent nature of numerical models, more sensitive analysis and rigorous validations are required to determine its measurement error and thus extend their application into clinical practice for personalized management. CRD42021125169.
在过去几十年中，基于数值模型，区域血流动力学在颅内动脉瘤形成、生长和破裂中的作用已得到广泛讨论。 Willis环（CoW）的变异会导致血流动力学变化，与动脉瘤的形成和破裂有关。然而，这种相关性尚未进一步阐明。本系统评价的目的是研究CoW的模拟血流动力学指标是否与颅内动脉瘤的形成、生长或破裂相关。我们按照PRISMA指南，对MEDLINE、科学网和EMBASE进行了检索，以查找截至2020年12月关于数值模型得出的CoW血流动力学指标与颅内动脉瘤之间相关性的研究。1046篇出版物中有3例病例报告符合我们的纳入和排除标准，报告了6例患者中的13个动脉瘤。11个动脉瘤未破裂，另外2个动脉瘤的状态未知。壁面切应力、振荡切变指数、冯·米塞斯应力、流速和流量被报告为血流动力学指标。由于病例有限且研究背景之间存在显著异质性，无法进行荟萃分析。数值模型可以提供有关脑血流以及颅内动脉瘤局部血流特征的全面信息。仅基于3例病例报告，无法就数值模型得出的CoW血流动力学参数与动脉瘤形成或破裂之间的相关性得出确凿结论。由于数值模型的固有性质，需要更敏感的分析和严格的验证来确定其测量误差，从而将其应用扩展到临床实践中进行个性化管理。CRD42021125169。
