Download PDF
Minim Invasive Neurosurg 2004; 47(3): 131-135
DOI: 10.1055/s-2004-818492
Original Article
© Georg Thieme Verlag Stuttgart · New York

Prediction of Impending Rupture in Aneurysms Using 4D-CTA: Histopathological Verification of a Real-Time Minimally Invasive Tool in Unruptured Aneurysms

Y.  Kato1 , M.  Hayakawa1 , H.  Sano1 , M.  V.  Sunil1 , S.  Imizu1 , M.  Yoneda1 , S.  Watanabe1 , M.  Abe2 , T.  Kanno1
  • 1Department of Neurosurgery, Fujita Health University, Toyoake, Japan
  • 2Department of Neuropathology, Fujita Health University, Toyoake, Japan
Further Information

Publication History

Publication Date:
02 September 2004 (online)

    Permissions and Reprints

Abstract

The authors describe the use of a 4D-CT angiogram to predict impending rupture in intact aneurysms, as a real-time, less invasive imaging technique. Histopathological verification and immunostaining of the bleb site performed on the study population reveals the significant predictive value of this tool. The point of maximum amplitude of pulsation of the aneurysm wall in unison with the RR interval of the electrocardiogram determines the potential rupture point. This helps in prioritizing the intervention for unruptured aneurysm cases, provides an effective screening of the high-risk population, and aids preoperative planning of clip application.

Key words

Rupture point - 4D-CT angiogram - unruptured aneurysms - histopathology - immunostaining

References

  • 1 Hademenos G J, Masssoud T F, Turjman F, Sayre J W. Anatomical and morphological factors correlating with rupture of intracranial aneurysms in patients referred for endovascular treatment.  Neuroradiology. 1988;  40 755-760
    PubMedGoogle Scholar
  • 2 Hope J KA, Wilson J L, Thomson F J. Three-dimensional CT angiography in the detection and characterization of intracranial berry aneurysms.  AJNR Am J Neuroradiol. 1996;  17 439-445
    PubMedGoogle Scholar
  • 3 Korogu Y, Takahashi M, Mabuchi N. et al . Intracranial aneurysms: diagnostic accuracy of MR angiography with evaluation of maximum intensity projection and source images.  Radiology. 1996;  199 199-207
    PubMedGoogle Scholar
  • 4 Setton A, Davis A J, Bose A. et al . Angiography of cerebral aneurysms.  Neuroimaging Clin N Am. 1996;  6 705-738
    PubMedGoogle Scholar
  • 5 Berenstein A, Flamm E S, Kupersmith M J. Unruptured intracranial aneurysms.  N Eng J Med. 1999;  340 1439-1440
    PubMedGoogle Scholar
  • 6 Connolly Jr E S, Mohr H P, Solomon R A. Unruptured intracranial aneurysms (Letter).  N Eng J Med. 1999;  340 1440-1441
    PubMedGoogle Scholar
  • 7 Caplan L R. Should intracranial aneurysms be treated before they rupture?.  N Eng J Med. 1998;  339 1774-1775
    PubMedGoogle Scholar
  • 8 Mitchell P, Jakubowski J. Failure testing cerebral arteries: are branch points weaker than unbranched vessels?.  Br J Neurosurg. 2002;  16 578-582
    PubMedGoogle Scholar
  • 9 Skirgaudas M, Awad I A, Kim J. et al . Expression of angiogenesis factors and selected vascular wall matrix proteins in intracranial saccular aneurysms.  Neurosurgery. 1996;  39 545-547
    PubMedGoogle Scholar
  • 10 Rinkel G J, Djibuti M, Gijn J van. Prevalence and risks of rupture of intracranial aneurysms. A systematic review.  Stroke. 1998;  29 251-256
    CrossrefPubMedGoogle Scholar
  • 11 Yoshimoto T, Mizoi K. Importance of management of ruptured cerebral aneurysms.  Surg Neurology. 1997;  47 522-526
    PubMedGoogle Scholar
  • 12 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability and risk factors for aneurysm rupture.  J Neurosurg. 2000;  93 379-387
    CrossrefPubMedGoogle Scholar
  • 13 Yasui N, Suzuki A, Nihimura H. et al . Long-term follow-up study of unruptured intracranial aneurysms.  Neurosurgery. 1997;  40 1155-1159
    PubMedGoogle Scholar
  • 14 Austin G M, Schievink W, Williams R. Controlled pressure-volume factors in the enlargement of intracranial aneurysms.  Neurosurgery. 1989;  24 722-730
    PubMedGoogle Scholar
  • 15 Canham P B, Finlay H M, Tong S Y. Stereological analysis of the layered collagen of human intracranial aneurysms.  J Micro Sc. 1996;  183 (Pt 2) 170-180
    PubMedGoogle Scholar
  • 16 Hayakawa M, Katada K, Anno H. et al .Imaging of cerebral aneurysm pulsation with ECG gated CT: Possible usefulness in the identification of aneurysmal rupture region. Proceedings of American Society of Neuroradiology 40th Annual Meeting 2002: 272
    Google Scholar
  • 17 Burleson A C, Strother C M, Turitto V T. Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics. Neurosurgery 1995 37 774-782 discussion 1995 37 782-784
    Google Scholar
  • 18 Ostergaard J R, Reske-Nielsen E, Oxlund H. Histological and morphometric observations on the reticular fibres in the arterial bed of patients with ruptured intracranial saccular aneurysms.  Neurosurgery. 1987;  20 554-558
    PubMedGoogle Scholar

Prof. Yoko Kato,  M. D.

Department of Neurosurgery · Fujita Health University

Toyoake

Aichi 4701192

Japan

Phone: +81-562-93-9253

Fax: +81-562-93-3118

Email: kyoko@fuita-hu.ac.jp

      >