Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture

Estevão, Iracema Araújo; Camporeze, Bruno; Araujo, Antonio Santos de; Nery, Breno; Antunes, Ápio Claudio Martins; Smith, Timothy R.; Aguiar, Paulo Henrique Pires de

doi:10.1590/0004-282X20170082

Acessibilidade / Reportar erro

Brasil

Arquivos de Neuro-Psiquiatria

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLES • Arq. Neuro-Psiquiatr. 75 (8) • Aug 2017 • https://doi.org/10.1590/0004-282X20170082 copy

Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture

Aneurismas da artéria cerebral média: morfologia angiográfica dos aneurismas e sua relação com ruptura pré-operatória e intra-operatória

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture.

Methods

Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture.

Results

Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4%) and 14/46 patients (30.4%) respectively. Thirty-two cases (69.6%) had no symptoms postoperatively, modified Rankin score (MRS) of 0; 6.5% had MRS of 1 (no significant disability); 13% had MRS of 2 (slight disability); 4.3% had moderately severe disability (MRS of 4); and there were 3 deaths (6.5%) post-operatively. The morphology was not directly related to the rupture rate.

Conclusion

In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.

aneurysm; subarachnoid hemorrhage; middle cerebral artery

Variable	Category	Frequency	Percentage
Pre-operative rupture	absent	38	82.6
Pre-operative rupture	present	8	17.4
Right sided middle cerebral artery bifurcation aneurysm	absent	23	50
Right sided middle cerebral artery bifurcation aneurysm	present	23	50
Left sided middle cerebral artery bifurcation aneurysm	absent	23	50
Left sided middle cerebral artery bifurcation aneurysm	present	23	50
Year of surgery	1998	4	8.7
	1999	1	2.2
	2005	1	2.2
	2006	3	6.5
	2007	2	4.3
	2008	8	17.4
	2009	6	13
	2010	2	4.3
	2011	2	4.3
	2012	5	10.9
	2013	5	10.9
	2014	2	4.3
	2015	5	10.9
Sex	female	32	69.6
Sex	male	14	30.4
Intra-operative rupture	absent	32	69.6
Intra-operative rupture	Present	14	30.4
Modified rankin score	0	32	69.6
	1	3	6.5
	2	6	13
	4	2	4.3
	6	3	6.5
Presence of associated right side aneurysms other than the bifurcation of the MCA	0	37	80.4
	1	7	15.2
	2	2	4.3
	> 2	0	0.0
Presence of associated Left Side Aneurysms other than the bifurcation of the MCA	0	42	91.3
	1	4	8.7
	2	0	0.0
	> 2	0	0.0
Pear-shaped middle cerebral artery aneurysm	Absent	32	69.6
Pear-shaped middle cerebral artery aneurysm	Present	14	30.4
Beak-shaped middle cerebral artery aneurysm	Absent	30	65.2
Beak-shaped middle cerebral artery aneurysm	Present	16	34.8
Globous-shaped middle cerebral artery aneurysm	Absent	37	80.4
Globous-shaped middle cerebral artery aneurysm	Present	9	19.6
Bilobar-shaped middle cerebral artery aneurysm	Absent	44	95.7
Bilobar-shaped middle cerebral artery aneurysm	Present	2	4.3
Multilobar-shaped middle cerebral artery aneurysm	Absent	43	93.5
Multilobar-shaped middle cerebral artery aneurysm	Present	3	6.5
Fusiform-shaped middle cerebral artery aneurysm	Absent	44	95.7
Fusiform-shaped middle cerebral artery aneurysm	Present	2	4.3
M1 segment longer than 3 cm	Absent	34	73.9
M1 segment longer than 3 cm	Present	12	26.1
Trifurcated middle cerebral artery	Absent	41	89.1
Trifurcated middle cerebral artery	Present	5	10.9
Aspect ratio > 1.5	Absent	18	39.1
Aspect ratio > 1.5	Present	28	60.9

Variable	Statistics	Right sided bifurcation middle cerebral artery aneurysm	Left sided bifurcation middle cerebral artery aneurysm	Presence of associated left side aneurysms other than the bifurcation of the MCA
Left sided middle cerebral artery bifurcation aneurysm	Coef. Correl. (r)	-1.000	—	—
	Sig. (p)	< 0.001	—	—
	n	46	—	—
Right sided middle cerebral artery bifurcation aneurysm	Coef. Correl. (r)	+0.031	-0.031	—
	Sig. (p)	0.839	0.839	—
	n	46	46	—
Presence of associated left sided aneurysms other than the bifurcation of the MCA	Coef. Correl. (r)	0.000	0.000	-0.152
	Sig. (p)	> 0.999	> 0.999	0.315
	n	46	46	46

Variable	n	Min	Max	Average	Standard deviation	Percentile 25	Percentile 50 (Median)	Percentile 75
Age	46	15	75	50.2	12.9	42	51.5	59.75
Size of the aneurysm	46	3	15	6.59	2.65	5	6	7.25

Middle cerebral artery aneurysm	Category	Pre-operative Rupture				Sig. (p)

		Absent		Present

		Frequency	Percentage	Frequency	Percentage
Pear-shaped	Absent	25	65.8	7	87.5	0.225
Pear-shaped	Present	13	34.2	1	12.5	0.225
Beak-shaped	Absent	24	63.2	6	75	0.523
Beak-shaped	Present	14	36.8	2	25	0.523
Globous-shaped	Absent	31	81.6	6	75	0.670
Globous-shaped	Present	7	18.4	2	25	0.670
Bilobar-shaped	Absent	37	97.4	7	87.5	0.213
Bilobar-shaped	Present	1	2.6	1	12.5	0.213
Multilobar-shaped	Absent	37	97.4	6	75	0.020
Multilobar-shaped	Present	1	2.6	2	25	0.020
Fusiform-shaped	Absent	36	94.7	8	100	0.507
Fusiform-shaped	Present	2	5.3	0	0.0	0.507

Middle cerebral artery aneurysm	Category	Intra-operative rupture				Sig. (p)

		Absent		Present

		Frequency	Percentage	Frequency	Percentage
Pear-shaped	Absent	24	75	8	57.1	0.226
Pear-shaped	Present	8	25	6	42.9	0.226
Beak-shaped	Absent	19	59.4	11	78.6	0.208
Beak-shaped	Present	13	40.6	3	21.4	0.208
Globous-shaped	Absent	27	84.4	10	71.4	0.308
Globous-shaped	Present	5	15.6	4	28.6	0.308
Bilobar-shaped	Absent	30	93.8	14	100	0.339
Bilobar-shaped	Present	2	6.3	0	0.0	0.339
Multilobar-shaped	Absent	30	93.8	13	92.9	0.910
Multilobar-shaped	Present	2	6.3	1	7.1	0.910
Fusifor-shaped	Absent	30	93.8	14	100	0.339
Fusifor-shaped	Present	2	6.3	0	0.0	0.339

Variable	Category	Pre-operative Rupture				Sig. (p)

		Absent		Present

		Frequency	Percentage	Frequency	Percentage
Right sided middle cerebral artery bifurcation aneurysm	Absent	19	50	4	50	> 0.999
Right sided middle cerebral artery bifurcation aneurysm	Present	19	50	4	50	> 0.999
Left sided middle cerebral artery bifurcation aneurysm	Absent	19	50	4	50	> 0.999
Left sided middle cerebral artery bifurcation aneurysm	Present	19	50	4	50	> 0.999
Sex	Female	26	68.4	6	75	0.713
Sex	Male	12	31.6	2	25	0.713
Presence of associated right side aneurysms other than the bifurcation of the MCA	0	29	76.3	8	100	0.308
	1	7	18.4	0	0.0
	2	2	5.3	0	0.0
	> 2	0	0,.0	0	0.0
Presence of associated left side aneurysms other than the bifurcation of the MCA	0	34	89.5	8	100	0.337
	1	4	10.5	0	0.0
	2	0	0.0	0	0.0
	> 2	0	0.0	0	0.0
M1 segment > 3 cm	Absent	29	76.3	5	62.5	0.419
M1 segment > 3 cm	Present	9	23.7	3	37.5	0.419
Trifurcated middle cerebral artery	Absent	34	89.5	7	87.5	0.871
Trifurcated middle cerebral artery	Present	4	10.5	1	12.5	0.871
Aspect ratio > 1.5	Absent	15	39.5	3	37.5	0.917
Aspect ratio > 1.5	Present	23	60.5	5	62.5	0.917

Variable	Category	Pre-operative Rupture				Sig. (p)

		Absent		Present

		Frequency	Percentage	Frequency	Percentage
Right sided middle cerebral artery bifurcation aneurysm	Absent	19	50	4	50	> 0.999
Right sided middle cerebral artery bifurcation aneurysm	Present	19	50	4	50	> 0.999
Left sided middle cerebral artery bifurcation aneurysm	Absent	19	50	4	50	> 0.999
Left sided middle cerebral artery bifurcation aneurysm	Present	19	50	4	50	> 0.999
Sex	Female	26	68.4	6	75	0.713
Sex	Male	12	31.6	2	25	0.713
Presence of associated right side aneurysms other than the bifurcation of the MCA	0	29	76.3	8	100	0.308
	1	7	18.4	0	0.0
	2	2	5.3	0	0.0
	> 2	0	0,.0	0	0.0
Presence of associated left side aneurysms other than the bifurcation of the MCA	0	34	89.5	8	100	0.337
	1	4	10.5	0	0.0
	2	0	0.0	0	0.0
	> 2	0	0.0	0	0.0
M1 segment > 3 cm	Absent	29	76.3	5	62.5	0.419
M1 segment > 3 cm	Present	9	23.7	3	37.5	0.419
Trifurcated middle cerebral artery	Absent	34	89.5	7	87.5	0.871
Trifurcated middle cerebral artery	Present	4	10.5	1	12.5	0.871
Aspect ratio > 1.5	Absent	15	39.5	3	37.5	0.917
Aspect ratio > 1.5	Present	23	60.5	5	62.5	0.917

Variable	Pre-operative rupture	n	Mean	SD	Min	Max	Percentile 25	Percentile 50 (Median)	Percentile 75	Sig. (p)
Age	Absent	38	50.76	13.46	15	75	42.75	52.00	62.00	0.303
	Present	8	47.50	10.09	32	65	39.5	49.50	52.50	0.303
	Total	46	50.20	12.90	15	75	42	51.50	59.75
Size of the aneurysm	Absent	38	6.37	2.57	3	15	5	6.00	7.00	0.209
	Present	8	7.63	2.93	5	12	5	7.00	11.00	0.209
	Total	46	6.59	2.65	3	15	5	6.00	7.25

Variable	Intra-operative Rupture	n	Mean	SD	Min	Max	Percentile 25	Percentile 50 (Median)	Percentile 75	Sig. (p)
Age	Absent	32	51.34	12.55	15	75	44.5	52	58.75	0.2624
	Present	14	47.57	13.78	21	67	38.75	46.5	62.75	0.2624
	Total	46	50.2	12.9	15	75	42	51.5	59.75
Size of the aneurysm	Absent	32	6.63	2.94	3	15	5	6	8	0.618
	Present	14	6.5	1.91	5	12	5	6.5	7	0.618
	Total	46	6.59	2.65	3	15	5	6	7.25

Variable	Statistics	Pear*	Beak*	Globous*	Bilobar*	Multilobar*	Fusiform*
Right sided middle cerebral artery bifurcation aneurysm	Coef. Correl. (r)	0.000	0.365	-0.164	0.000	-0.264	-0.213
	Sig. (p)	> 0.999	0,013	0.275	> 0.999	0.076	0.155
	n	46	46	46	46	46	46
Left sided middle cerebral artery bifurcation aneurysm	Coef. Correl. (r)	0.000	-0.365	0.164	0.000	0.264	0.213
	Sig. (p)	> 0.999	0.013	0.275	> 0.999	0.076	0.155
	n	46	46	46	46	46	46
Age	Coef. Correl. (r)	0.153	0.002	-0.008	0.088	-0.100	-0.301
	Sig. (p)	0.310	0.991	0.957	0.559	0.510	0.042
	n	46	46	46	46	46	46
Sex	Coef. Correl. (r)	0.076	-0.086	-0.088	0.091	0.017	0.091
	Sig. (p)	0.616	0.569	0.561	0.549	0.913	0.549
	n	46	46	46	46	46	46
Modified rankin score	Coef. Correl. (r)	0.042	-0.027	-0.043	-0.138	0.273	-0.138
	Sig. (p)	0.784	0.856	0.776	0.359	0.066	0.359
	n	46	46	46	46	46	46
Presence of associated right side aneurysms other than the bifurcation of the MCA	Coef. Correl. (r)	0.289	0.080	-0.242	-0.105	-0.130	-0.105
	Sig. (p)	0.052	0.598	0.105	0.489	0.390	0.489
	n	46	46	46	46	46	46
Presence of associated left side aneurysms other than the bifurcation of the MCA	Coef. Correl. (r)	-0.036	0.099	0.042	-0.066	-0.082	-0.066
	Sig. (p)	0.810	0.514	0.780	0.664	0.590	0.664
	n	46	46	46	46	46	46
Size of the aneurysm	Coef. Correl. (r)	-0.112	-0.505	0.448	0.057	0.128	0.348
	Sig. (p)	0.457	< 0.001	0.002	0.705	0.395	0.018
	n	46	46	46	46	46	46
M1 segment > 3 cm	Coef. Correl. (r)	-0.178	-0.018	0.206	-0.127	-0.157	0.359
	Sig. (p)	0.237	0.905	0.169	0.402	0.298	0.014
	n	46	46	46	46	46	46
Trifurcated middle cerebral artery	Coef. Correl. (r)	-0.079	0.038	0.004	0.268	-0.092	-0.074
	Sig. (p)	0.601	0.801	0.980	0.072	0.542	0.623
	n	46	46	46	46	46	46
Aspect ratio > 1,5	Coef. Correl. (r)	-0.051	-0.163	0.283	-0.047	-0.149	0.171
	Sig. (p)	0.739	0.280	0.057	0.754	0.323	0.256
	n	46	46	46	46	46	46

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Iracema Araújo Estevão; Rua Ercílio Baratella, 334, Edifício Mônica; 12916-370 Bragança Paulista SP, Brasil; E-mail: iaestevão@gmail.com