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The Frequency of Subarachnoid Hemorrhage from Very Small Cerebral Aneurysms (< 5 mm): A Population-Based Study.

Dolati P, Pittman D, Morrish WF, Wong J, Sutherland GR - Cureus (2015)

Bottom Line: The average size of the dome, neck, and the aspect ratio was 6.6±4.4 mm (range: 1.5-26 mm), 3.1 mm, and 2.6±0.9, respectively.Forty-six patients (37%) had a ruptured aneurysm with dome size < 5 mm (range: 1.5-4.9 mm).When unruptured, looking for other risk factors for rupture is highly recommended before simply leaving them alone.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neurosurgery, Beth Israel Deaconess Medical Center.

ABSTRACT

Background:  The prevailing view amongst neurosurgeons is that the larger the aneurysm, the higher the chance of rupture. This implies that very small aneurysms rarely rupture. To investigate this theory, we conducted a cross-sectional hospital-based study of aneurysmal subarachnoid hemorrhage, with an emphasis on aneurysm size at the time of rupture.

Methods:  We retrospectively reviewed hospital records and radiological tests of all patients admitted to Foothills Medical Center, Calgary, Alberta, with a ruptured saccular aneurysm from January 2008 to January 2012. The size of the dome and neck (in millimeters), the aspect ratio (aneurysm depth to aneurysm neck), and location of the aneurysms were determined using preoperative computed tomography angiography and digital subtraction angiography.

Findings:  One hundred and twenty-three patients with a ruptured saccular aneurysm were identified. The average size of the dome, neck, and the aspect ratio was 6.6±4.4 mm (range: 1.5-26 mm), 3.1 mm, and 2.6±0.9, respectively. Forty-six patients (37%) had a ruptured aneurysm with dome size < 5 mm (range: 1.5-4.9 mm). For these small aneurysms, the average size of the dome, neck, and the aspect ratio was 3.9+1.1 mm, 1.6 mm, and 2.1+0.6, respectively. The anterior communicating artery was the most common location regardless of size.

Conclusion:  Small aneurysms (< 5 mm) are a common cause of aneurysmal subarachnoid hemorrhage. When unruptured, looking for other risk factors for rupture is highly recommended before simply leaving them alone.

No MeSH data available.


Related in: MedlinePlus

Digital subtraction angiography (DSA) of different sized ruptured aneurysms.A and B (both AP views), pre- and post-coiling of a 2 mm anterior communicating artery (AComA) aneurysm. C (AP view) and D (Submentovertex view), pre- and post-clipping of a 2.5 mm right middle cerebral artery (MCA) aneurysm. In Fig. D, the arrow points to the clip’s tip. E and F (both AP views), Pre- and post-coiling of a 9 mm AComA aneurysm, and finally, G and H (both oblique views), pre- and post-coiling of a 26 mm right MCA aneurysms. They had presented with SAH Grade 4, 3, 2, and 1, respectively. 
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FIG1: Digital subtraction angiography (DSA) of different sized ruptured aneurysms.A and B (both AP views), pre- and post-coiling of a 2 mm anterior communicating artery (AComA) aneurysm. C (AP view) and D (Submentovertex view), pre- and post-clipping of a 2.5 mm right middle cerebral artery (MCA) aneurysm. In Fig. D, the arrow points to the clip’s tip. E and F (both AP views), Pre- and post-coiling of a 9 mm AComA aneurysm, and finally, G and H (both oblique views), pre- and post-coiling of a 26 mm right MCA aneurysms. They had presented with SAH Grade 4, 3, 2, and 1, respectively. 

Mentions: Table 3 shows the frequency of ruptured intracranial aneurysms based on their location and size of the rupture. Ninety-four percent of aneurysms < 5 mm and 83% of aneurysms > 5 mm were located in the anterior circulation. In the posterior circulation, the overall frequency of aneurysms was very low, although most of them had a diameter > 5 mm. The anterior communicating artery was the most common location of the RIAs irrespective of the size, followed by the middle cerebral artery. Some examples of small versus larger ruptured aneurysms are presented in Figure 1.


The Frequency of Subarachnoid Hemorrhage from Very Small Cerebral Aneurysms (< 5 mm): A Population-Based Study.

Dolati P, Pittman D, Morrish WF, Wong J, Sutherland GR - Cureus (2015)

Digital subtraction angiography (DSA) of different sized ruptured aneurysms.A and B (both AP views), pre- and post-coiling of a 2 mm anterior communicating artery (AComA) aneurysm. C (AP view) and D (Submentovertex view), pre- and post-clipping of a 2.5 mm right middle cerebral artery (MCA) aneurysm. In Fig. D, the arrow points to the clip’s tip. E and F (both AP views), Pre- and post-coiling of a 9 mm AComA aneurysm, and finally, G and H (both oblique views), pre- and post-coiling of a 26 mm right MCA aneurysms. They had presented with SAH Grade 4, 3, 2, and 1, respectively. 
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494560&req=5

FIG1: Digital subtraction angiography (DSA) of different sized ruptured aneurysms.A and B (both AP views), pre- and post-coiling of a 2 mm anterior communicating artery (AComA) aneurysm. C (AP view) and D (Submentovertex view), pre- and post-clipping of a 2.5 mm right middle cerebral artery (MCA) aneurysm. In Fig. D, the arrow points to the clip’s tip. E and F (both AP views), Pre- and post-coiling of a 9 mm AComA aneurysm, and finally, G and H (both oblique views), pre- and post-coiling of a 26 mm right MCA aneurysms. They had presented with SAH Grade 4, 3, 2, and 1, respectively. 
Mentions: Table 3 shows the frequency of ruptured intracranial aneurysms based on their location and size of the rupture. Ninety-four percent of aneurysms < 5 mm and 83% of aneurysms > 5 mm were located in the anterior circulation. In the posterior circulation, the overall frequency of aneurysms was very low, although most of them had a diameter > 5 mm. The anterior communicating artery was the most common location of the RIAs irrespective of the size, followed by the middle cerebral artery. Some examples of small versus larger ruptured aneurysms are presented in Figure 1.

Bottom Line: The average size of the dome, neck, and the aspect ratio was 6.6±4.4 mm (range: 1.5-26 mm), 3.1 mm, and 2.6±0.9, respectively.Forty-six patients (37%) had a ruptured aneurysm with dome size < 5 mm (range: 1.5-4.9 mm).When unruptured, looking for other risk factors for rupture is highly recommended before simply leaving them alone.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neurosurgery, Beth Israel Deaconess Medical Center.

ABSTRACT

Background:  The prevailing view amongst neurosurgeons is that the larger the aneurysm, the higher the chance of rupture. This implies that very small aneurysms rarely rupture. To investigate this theory, we conducted a cross-sectional hospital-based study of aneurysmal subarachnoid hemorrhage, with an emphasis on aneurysm size at the time of rupture.

Methods:  We retrospectively reviewed hospital records and radiological tests of all patients admitted to Foothills Medical Center, Calgary, Alberta, with a ruptured saccular aneurysm from January 2008 to January 2012. The size of the dome and neck (in millimeters), the aspect ratio (aneurysm depth to aneurysm neck), and location of the aneurysms were determined using preoperative computed tomography angiography and digital subtraction angiography.

Findings:  One hundred and twenty-three patients with a ruptured saccular aneurysm were identified. The average size of the dome, neck, and the aspect ratio was 6.6±4.4 mm (range: 1.5-26 mm), 3.1 mm, and 2.6±0.9, respectively. Forty-six patients (37%) had a ruptured aneurysm with dome size < 5 mm (range: 1.5-4.9 mm). For these small aneurysms, the average size of the dome, neck, and the aspect ratio was 3.9+1.1 mm, 1.6 mm, and 2.1+0.6, respectively. The anterior communicating artery was the most common location regardless of size.

Conclusion:  Small aneurysms (< 5 mm) are a common cause of aneurysmal subarachnoid hemorrhage. When unruptured, looking for other risk factors for rupture is highly recommended before simply leaving them alone.

No MeSH data available.


Related in: MedlinePlus