Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

  • Choi, Hyun Ho (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Cho, Young Dae (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Yoo, Dong Hyun (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Jeongjun (Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Mun, Jong Hyeon (Department of Neurosurgery, Kwangju Christian Hospital) ;
  • An, Sang Joon (Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University of Korea College of Medicine) ;
  • Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Cho, Won-Sang (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Jeong Eun (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Han, Moon Hee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2017.09.17
  • Accepted : 2018.02.03
  • Published : 2018.10.01
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Abstract

Objective: Mirror aneurysms are generally considered as a subset of multiple aneurysms, defined as aneurysms occurring bilaterally and symmetrically on the same-named vessels. Although not infrequent, the characteristics of mirror aneurysms are not well studied. This investigation was conducted to elucidate the anatomic features of such lesions and examine treatment options. Materials and Methods: A retrospective review was conducted, aimed at 172 patients treated for 344 mirror aneurysms between January 2007 and December 2015. Aneurysms of similar nature but in asymmetric locations on the same-named vessels were excluded. All available records were examined and lesion characteristics, as well as treatment outcomes were assessed. Results: In study subjects (n = 172), mirror aneurysms most often involved middle cerebral artery bifurcation (n = 83), followed by a paraclinoid internal carotid artery (n = 50) and posterior communicating artery (n = 21). Most of the lesions (95.3%) measured ${\leq}10mm$, and in 126 patients (74.6%), the size ratios were > 50%. Of the 344 aneurysms studied, coil embolization was undertaken in 217, surgical clipping in 62, and observation alone (no treatment) in 65. Coil embolization and surgical clipping were done bilaterally in 83 and 12 patients, respectively. In 12 patients, combined coiling and clipping were implemented on each side. Single-stage coil embolization of both the aneurysms was performed in 73 patients, with excellent post-procedural (85.6%) and follow-up (86.8%) occlusive results. There was no procedure-related morbidity or mortality. Conclusion: By adopting different treatment strategies to different configurations and vascular sources, mirror aneurysms can be safely and effectively treated. If feasible, single-stage coil embolization should be considered as a reasonable treatment option for mirror aneurysms.

Keywords

References

  1. Rinkel GJ. Natural history, epidemiology and screening of unruptured intracranial aneurysms. Rev Neurol (Paris) 2008;164:781-786 https://doi.org/10.1016/j.neurol.2008.07.012
  2. Brown RD. Unruptured intracranial aneurysms. Semin Neurol 2010;30:537-544 https://doi.org/10.1055/s-0030-1268858
  3. Brown RD Jr, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 2014;13:393-404 https://doi.org/10.1016/S1474-4422(14)70015-8
  4. Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:2368-2400 https://doi.org/10.1161/STR.0000000000000070
  5. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103-110 https://doi.org/10.1016/S0140-6736(03)13860-3
  6. Lu HT, Tan HQ, Gu BX, Wu-Wang, Li MH. Risk factors for multiple intracranial aneurysms rupture: a retrospective study. Clin Neurol Neurosurg 2013;115:690-694 https://doi.org/10.1016/j.clineuro.2012.08.011
  7. Ellamushi HE, Grieve JP, Jager HR, Kitchen ND. Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg 2001;94:728-732
  8. Juvela S. Risk factors for multiple intracranial aneurysms. Stroke 2000;31:392-397 https://doi.org/10.1161/01.STR.31.2.392
  9. Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke 2003;34:16-21 https://doi.org/10.1161/01.STR.0000046763.48330.AD
  10. Nehls DG, Flom RA, Carter LP, Spetzler RF. Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 1985;63:342-348
  11. Meissner I, Torner J, Huston J 3rd, Rajput ML, Wiebers DO, Jones LK Jr, et al.; International Study of Unruptured Intracranial Aneurysms Investigators. Mirror aneurysms: a reflection on natural history. J Neurosurg 2012;116:1238-1241
  12. Lee YJ, Parreira T, Matouk CC, Menezes R, Mandell DM, terBrugge KG, et al. Clinical characteristics and preferential location of intracranial mirror aneurysms: a comparison with non-mirror multiple and single aneurysms. Neuroradiology 2015;57:35-40 https://doi.org/10.1007/s00234-014-1437-9
  13. Wang R, Zhang D, Zhao J, Wang S, Zhao Y, Niu H. A comparative study of 43 patients with mirror-like intracranial aneurysms: risk factors, treatment, and prognosis. Neuropsychiatr Dis Treat 2014;10:2231-2237
  14. Baccin CE, Krings T, Alvarez H, Ozanne A, Lasjaunias P. Multiple mirror-like intracranial aneurysms. Report of a case and review of the literature. Acta Neurochir (Wien) 2006;148:1091-1095; discussion 1095 https://doi.org/10.1007/s00701-006-0860-z
  15. Casimiro MV, McEvoy AW, Watkins LD, Kitchen ND. A comparison of risk factors in the etiology of mirror and nonmirror multiple intracranial aneurysms. Surg Neurol 2004;61:541-545 https://doi.org/10.1016/j.surneu.2003.08.016
  16. Mehrotra A, Sharma P, Das KK, Bhaisora KS, Sardhara J, Gupta S, et al. Mirror aneurysms among multiple aneurysms: lesser of the two evils. World Neurosurg 2016;92:126-132 https://doi.org/10.1016/j.wneu.2016.04.124
  17. Lesley WS. Bilateral mirror posterior inferior cerebellar artery aneurysms: diagnostic caveat on catheter angiography. J Neurointerv Surg 2011;3:383-385 https://doi.org/10.1136/jnis.2010.004200
  18. Xu Y, Chen SD, Lei B, Zhang WH, Wang WY. One-stage operation for rare multiple mirror intracranial aneurysms: a case report and literature review. Turk Neurosurg 2014;24:598-601
  19. Enesi E, Rroji A, Demneri M, Vreto G, Petrela M. Mirror image distal anterior cerebral artery aneurysms treated with coil embolization. a report of two cases and literature review. Interv Neuroradiol 2013;19:49-55 https://doi.org/10.1177/159101991301900107
  20. Yamada K, Nakahara T, Kishida K, Yano T, Yamamoto K, Ushio Y. Multiple "mirror" aneurysms involving intracavernous carotid arteries and vertebral arteries: case report. Surg Neurol 2000;54:361-365 https://doi.org/10.1016/S0090-3019(00)00304-9
  21. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-1403 https://doi.org/10.1161/01.STR.0000073841.88563.E9
  22. Jeon JP, Cho YD, Rhim JK, Park JJ, Cho WS, Kang HS, et al. Stent-assisted coil embolization of vertebrobasilar dissecting aneurysms: procedural outcomes and factors for recanalization. Korean J Radiol 2016;17:801-810 https://doi.org/10.3348/kjr.2016.17.5.801
  23. Feng Y, Wada S, Tsubota K, Yamaguchi T. The application of computer simulation in the genesis and development of intracranial aneurysms. Technol Health Care 2005;13:281-291
  24. Wang F, Xu B, Sun Z, Wu C, Zhang X. Wall shear stress in intracranial aneurysms and adjacent arteries. Neural Regen Res 2013;8:1007-1015
  25. Munarriz PM, Gomez PA, Paredes I, Castano-Leon AM, Cepeda S, Lagares A. Basic principles of hemodynamics and cerebral aneurysms. World Neurosurg 2016;88:311-319 https://doi.org/10.1016/j.wneu.2016.01.031
  26. Hoh BL, Sistrom CL, Firment CS, Fautheree GL, Velat GJ, Whiting JH, et al. Bottleneck factor and height-width ratio: association with ruptured aneurysms in patients with multiple cerebral aneurysms. Neurosurgery 2007;61:716-722; discussion 722-723 https://doi.org/10.1227/01.NEU.0000298899.77097.BF
  27. Baumann F, Khan N, Yonekawa Y. Patient and aneurysm characteristics in multiple intracranial aneurysms. Acta Neurochir Suppl 2008;103:19-28
  28. Wang WX, Xue Z, Li L, Wu C, Zhang YY, Lou X, et al. Treatment strategies for intracranial mirror aneurysms. World Neurosurg 2017;100:450-458 https://doi.org/10.1016/j.wneu.2017.01.049
  29. Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Management outcome for multiple intracranial aneurysms. Neurosurgery 1995;36:31-37; discussion 37-38 https://doi.org/10.1227/00006123-199501000-00003
  30. Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir (Wien) 1989;96:8-14 https://doi.org/10.1007/BF01403489
  31. Rodriguez-Hernandez A, Gabarros A, Lawton MT. Contralateral clipping of middle cerebral artery aneurysms: rationale, indications, and surgical technique. Neurosurgery 2012;71(1 Suppl Operative):116-123; discussion 123-124
  32. Wachter D, Kreitschmann-Andermahr I, Gilsbach JM, Rohde V. Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm? J Neurosurg 2011;114:935-941
  33. Hong T, Wang Y. Unilateral approach to clip bilateral multiple intracranial aneurysms. Surg Neurol 2009;72 Suppl 1:S23-S28; discussion S28 https://doi.org/10.1016/j.surneu.2007.12.031
  34. Santana Pereira RS, Casulari LA. Surgical treatment of bilateral multiple intracranial aneurysms. Review of a personal experience in 69 cases. J Neurosurg Sci 2006;50:1-8
  35. Xavier AR, Rayes M, Pandey P, Tiwari A, Kansara A, Guthikonda M. The safety and efficacy of coiling multiple aneurysms in the same session. J Neurointerv Surg 2012;4:27-30 https://doi.org/10.1136/jnis.2009.001974
  36. Cho YD, Ahn JH, Jung SC, Kim CH, Cho WS, Kang HS, et al. Single-stage coil embolization of multiple intracranial aneurysms: technical feasibility and clinical outcomes. Clin Neuroradiol 2016;26:285-290 https://doi.org/10.1007/s00062-014-0367-6
  37. Andic C, Aydemir F, Kardes O, Gedikoglu M, Akin S. Singlestage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once? J Neurointerv Surg 2017;9:1069-1074 https://doi.org/10.1136/neurintsurg-2016-012745
  38. Jing L, Liu J, Zhang Y, Paliwal N, Meng H, Wang S, et al. Analysis of multiple intracranial aneurysms with different outcomes in the same patient after endovascular treatment. World Neurosurg 2016;91:399-408 https://doi.org/10.1016/j.wneu.2016.04.072
  39. Jeon P, Kim BM, Kim DJ, Kim DI, Suh SH. Treatment of multiple intracranial aneurysms with 1-stage coiling. AJNR Am J Neuroradiol 2014;35:1170-1173 https://doi.org/10.3174/ajnr.A3821