title: Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.forename: Allen
authors.initials: A
authors.lastname: Ho
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
authors.forename: Steven
authors.initials: S
authors.lastname: Pieper
authors.forename: Kai U
authors.initials: KU
authors.lastname: Frerichs
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Day
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D019635:Neurosurgical Procedures; D012307:Risk Factors; D014057:Tomography, X-Ray Computed