Risk of aneurysmal rupture: the importance of neck orifice positioning-assessment using computational flow simulation.
OBJECTIVE
The aim of the present study was to clarify the risk of rupture in terminal-type intracranial aneurysms using computational flow simulation analysis.


METHODS
First, idealized three-dimensional aneurysmal models were built from a solid voxel on the computer. We focused on round terminal-type aneurysms with the positioning of the neck orifice set according to the following three patterns in relationship to the axis of the parent artery: the Type-A neck orifice was positioned directly in line with the flow of the parent artery; the Type-B neck orifice was shifted 1.5 mm offline toward the unilateral branch; and the Type-C neck orifice was shifted 3 mm offline. Computational flow simulations were applied with Fujitsu alpha-Flow software (Fujitusu, Tokyo, Japan). We analyzed flow patterns using modified patient-specific models. We also investigated actual clinical situations to evaluate the differences in neck-orifice positioning between 20 ruptured aneurysms and 26 unruptured ones using three-dimensional angiograms.


RESULTS
The Type-A neck orifice showed completely symmetrical stream lines in the aneurysm, whereas the Type-C orifice showed a clear round circulation. The Type-B neck orifice, on the other hand, exhibited intra-aneurysmal flow separation. The clinical research demonstrated that Type-B aneurysms were more likely to be found in the ruptured group (P < 0.05).


CONCLUSIONS
Flow separation, recognized as one of the causes of intimal injury, could be observed only in Type-B aneurysms, a result that corresponded well with our clinical experience. From the flow-dynamics point of view, this positioning of the neck orifice may be one of the risk factors most likely to induce the rupture of unruptured aneurysms.
Ohshima
Tomotaka
T
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Miyachi
Shigeru
S
Hattori
Ken-Ichi
K
Takahashi
Ichiro
I
Ishii
Katsuya
K
Izumi
Takashi
T
Yoshida
Jun
J
D017542:Aneurysm, Ruptured / Q000503:physiopathology*; D001783:Blood Flow Velocity; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D003198:Computer Simulation; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology*; D008955:Models, Cardiovascular; D008959:Models, Neurological; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000503:physiopathology