Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms Clinical article
Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms Clinical article
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DOI：
10.3171/2012.7.jns111766
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发表时间：
2012-11-01
影响因子：
4.1
通讯作者：
Du, Rose
中科院分区：
文献类型：
--
作者：
Lin, Ning;Ho, Allen;Du, Rose
Object.未破裂颅内动脉瘤的处理在神经外科中仍然存在争议。形态学参数的贡献尚未以系统的方式或针对任何特定动脉瘤位置纳入治疗范例。作者介绍了一个大样本的大脑中动脉（MCA）动脉瘤，使用形态学变量进行评估，以确定与动脉瘤破裂相关的参数。使用Slicer软件评价术前CT血管造影（CTA）研究，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文献中已经定义的5个变量（动脉瘤尺寸、纵横比、动脉瘤角度、血管角度和尺寸比）和3个新变量（血流角度、与动脉瘤的距离和父子角）。单因素和多因素统计分析确定统计学意义。在2005年至2008年期间，132例MCA动脉瘤在一家机构接受了治疗，并对79例动脉瘤（40例破裂和39例未破裂）的CTA研究进行了分析。53例动脉瘤因再次手术（4例）和相关AVM（2例）而被排除。或缺乏术前CTA研究（47）。破裂的动脉瘤与更大的尺寸、更大的纵横比、更大的动脉瘤和血流角以及更小的亲子角相关。多因素Logistic回归分析显示，纵横比、血流角、亲子角是与破裂型膀胱炎相关性最强的因素。长宽比、血流角和父子角与破裂的MCA动脉瘤的相关性比动脉瘤的大小更强。独立于动脉瘤形态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风险增加相关。这些因素很容易应用于临床实践，在评估MCA位置特定动脉瘤破裂风险时，除了动脉瘤尺寸外，还应考虑这些因素。(http：//thejns.org/doi/abs/10.3171/2012.7.JNS11766）
Object. 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.Methods. 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.Results. 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.Conclusions. 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. (http://thejns.org/doi/abs/10.3171/2012.7.JNS11766)