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http://dx.doi.org/10.3340/jkns.2009.45.2.85

What Is the Significance of a Large Number of Ruptured Aneurysms Smaller than 7 mm in Diameter?  

Joo, Sang-Wook (Department of Neurosurgery, Inje University School of Medicine, Pusan Paik Hospital)
Lee, Sun-Il (Department of Neurosurgery, Inje University School of Medicine, Pusan Paik Hospital)
Noh, Seung-Jin (Department of Neurosurgery, Inje University School of Medicine, Pusan Paik Hospital)
Jeong, Young-Gyun (Department of Neurosurgery, Inje University School of Medicine, Pusan Paik Hospital)
Kim, Moo-Seong (Department of Neurosurgery, Inje University School of Medicine, Pusan Paik Hospital)
Jeong, Yong-Tae (Department of Neurosurgery, Inje University School of Medicine, Pusan Paik Hospital)
Publication Information
Journal of Korean Neurosurgical Society / v.45, no.2, 2009 , pp. 85-89 More about this Journal
Abstract
Objective : The International Study of Unruptured Intracranial Aneurysms (ISUIA) reported that the 5-year cumulative rupture rate of small unruptured aneurysms less than 7 mm in diameter is very low depending on the aneurysm's location. However, we have seen a large number of ruptured aneurysms less than 7 mm in clinical practice. The purpose of this study was to review our experience and to measure the size and location at which aneurysms ruptured in our patient population. Methods : We reviewed the characteristics of aneurysms, such as size and location, from the original angiograms of patients who were admitted to our hospital between January 2004 and December 2007. All aneurysms were treated surgically or through endovascular procedures. Results : Interventional or surgical treatment was given to a total of 889 patients, including 568 females and 321 males. At the time of our study, 627 cases were ruptured aneurysms and 262 cases were unruptured aneurysms. Of the ruptured cases, the mean diameter of the aneurysm was 6.28 mm. We found that 71.8% of ruptured aneurysms were smaller than 7 mm in diameter, and 87.9%, were smaller than 10 mm. Based on location, the data show that anterior communicating artery aneurysms most often presented with rupture sizes less than 7 mm (76.8%) and 10 mm (92.1%) in diameter. Most ruptured aneurysms were less than 7 mm in size, although recent studies have noted that small aneurysms are less likely to rupture. Conclusion : Although the natural history of unruptured intracranial aneurysms remains controversial, the aneurysm size and location play a signigicant role in determining the risk of rupture. Larger sample sizes and a long term study are needed to reveal the natural history and the rupture risk of unruptured intracranial aneurysms because the size of most ruptured aneurysms was less than 7 mm in diameter in our series.
Keywords
Size; Location; Age; Intracranial aneurysm; Rupture;
Citations & Related Records

Times Cited By Web Of Science : 4  (Related Records In Web of Science)
Times Cited By SCOPUS : 10
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1 Hope Jk, Wilson Jl, Thomson FJ : Three-dimensional CT angiography in the detection and characterization of intracranial berry aneurysms. AJNR Am J Neuroradiol 17 : 439-445, 1996
2 Jakubowski J, Kendall B : Coincidental aneurysms with tumors of pituitary origin. J Neurol Neurosurg Psychiatry 41 : 972-979, 1978   DOI
3 Jellinger K : Pathology of intracerebral hemorrhage. Zentralbl Neurochir 38 : 29-42, 1977
4 Morita A, Fujiwara S, Hashi K, Ohtsu H, Kirino T : Risk of rupture associated with intact cerebral aneurysms in the Japanese population : a systematic review of the literature from Japan. J Neurosurg 102 : 601-606, 2005   DOI   ScienceOn
5 Ohashi Y, Horikoshi T, Sugita M, Yagishita T, Nukui H : Size of cerebral aneurysms and related factores in patients with subarachnoid hemorrhage. Surg Neurol 61 : 239-245; discussion 245-247, 2004   DOI   ScienceOn
6 Rinkel GJ, Djibuti M, Algra A, van Gijn J : Prevalence and risk of rupture of intracranial aneurysms : systematic review. Stroke 29 : 251-256, 1998   DOI   ScienceOn
7 Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ : Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics : an updated meta-analysis. Stroke 38 : 1404-1410, 2007   DOI   ScienceOn
8 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 362 : 103-110, 2003   DOI   ScienceOn
9 Tsukahara T, Murakami N, Sakurai Y, Yonekura M, Takahashi T, Inoue T, et al : Treatment of unruptured cerebral aneurysms; a multi-center study at Japanese national hospitals. Acta Neurochir Suppl 94 : 77-85, 2005   DOI
10 McCormick WF, Acosta-Rua GJ : The size of intracranial saccular aneuysms : an autopsy study. J Neurosurg 33 : 422-427, 1970   DOI
11 Maeder PP, Meuli RA, de Tribolet N : Three-dimensional volume rendering for magnetic resonance angiography in the screening and preoperative workup of intracranial aneurysms. J Neurosurg 85 : 1050-1055, 1996   DOI   ScienceOn
12 Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. International Study of Unruptured Intracranial Aneurysms Investigators. N Engl J Med 339 : 1725-1733, 1998   DOI   PUBMED   ScienceOn
13 Brilastra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A : Treatment of intracranial aneurysms by embolization with coils : a systematic review. Stroke 30 : 470-476, 1999   DOI   ScienceOn
14 Hop JW, Rinkel GJ, Algra A, van Gijn J : Case-fatality rates and functional outcome after subarachnoid hemorrhage : a systemic review. Stroke 28 : 660-664, 1997   DOI   ScienceOn
15 Raaymakers TW, Rinkel GJ, Limburg M, Algra A : Mortality and morbidity of surgery for unruptured intracranial aneurysms : a meta-analysis. Stroke 29 : 1531-1538, 1998   DOI   ScienceOn
16 Forget TR Jr, Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, et al : A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49 : 1322-1325; discussion 1325-1326, 2001   DOI   ScienceOn
17 Juvela S, Porras M, Poussa K : Natural history of unruptured intracranial aneurysms : probability of and risk factors for aneurysm rupture. J Neurosurg 93 : 379-387, 2000   DOI   ScienceOn
18 Heiskanen O : Risk of bleeding from runruptured aneurysm in cases with multiple intracranial aneurysms. J Neurosurg 55 : 524-526, 1981   DOI   PUBMED
19 Qureshi AI, Sung GY, Suri MF, Straw RN, Guterman LR, Hopkins LN : Factors associated with aneurysm size in patients with subarachnoid hemorrhage : effect of smoking and aneurysm location. Neurosurgery 46 : 44-50, 2000
20 Korogi Y, Takahashi M, Mabuchi N, Nakagawa T, Fujiwara S, Horikawa Y, et al : Intracranial aneurysms : diagnostic accuracy of MR angiography with evaluation of maximum intensity projection and source images. Radiology 199 : 199-207, 1996   DOI
21 Orz Y, Kobayashi S, Osawa M, Tanaka Y : Aneurysm size : a prognostic factor for rupture. Br J Neurosurg 11 : 144-149, 1997   DOI   ScienceOn
22 Beck J, Rohde S, Berkefeld J, Seifert V, Raabe A : Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography. Surg Neurol 65 : 18-25; discussion 25-27, 2006   DOI   ScienceOn
23 Yasui N, Suzuki A, Nishimura H, Suzuki K, Abe T : Long-term follow-up study of unruptured intracranial aneurysms. Neurosurgery 40 : 1155-1159; discussion 1159-1160, 1997   DOI   ScienceOn
24 Juvela S, Porras M, Heiskanen O : Natural history of unruptured intracranial aneurysms : a long-term follow-up study. J Neurosurg 79 : 174-182, 1993   DOI   ScienceOn
25 Weir B, Disney L, Karrison T : Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 96 : 64-70, 2002   DOI   ScienceOn
26 Winn HR, Almaani WS, Berga SL, Jane JA, Richardson AE : The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59 : 642-651, 1983   DOI
27 Tsutsumi K, Ueki K, Morita A, Kirino T : Risk of rupture from incidental cerebral aneurysms. J Neurosurg 93 : 550-553, 2000   DOI   ScienceOn