Julius Dengler1, Nicolai Maldaner1, Philippe Bijlenga2, Jan-Karl Burkhardt3, Alexander Graewe4, Susanne Guhl5, Bujung Hong6, Christian Hohaus7, Adisa Kursumovic8, Dorothee Mielke9, Karl-Michael Schebesch10, Maria Wostrack11, Daniel Rufenacht12, Peter Vajkoczy1, Nils Ole Schmidt13. 1. Department of Neurosurgery, Charité-Universitaetsmedizin Berlin; 2. Service de Neurochirurgie, Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève; and. 3. Department of Neurosurgery, University Hospital of Zurich, Switzerland. 4. Department of Neurosurgery, Unfallkrankenhaus Berlin; 5. Department of Neurosurgery, University of Greifswald; 6. Department of Neurosurgery, Hannover Medical School, Hannover; 7. Department of Neurosurgery, BG Hospital Bergmannstrost, Halle; 8. Department of Neurosurgery and Interventional Neuroradiology, Klinikum Deggendorf; 9. Department of Neurosurgery, Georg-August-University Goettingen; 10. Department of Neurosurgery, University of Regensburg; 11. Department of Neurosurgery, Technical University of Munich; 12. Zentrum fuer Neuroradiologie, Clinic Hirslanden, Zurich; 13. Department of Neurosurgery, University Medical Center, Hamburg Eppendorf, Germany;
Abstract
OBJECT: The underlying mechanisms causing intracranial perianeurysmal edema (PAE) are still poorly understood. Since PAE is most frequently observed in giant intracranial aneurysms (GIAs), the authors designed a study to examine the occurrence of PAE in relation to the location, size, and partial thrombosis (PT) of GIAs along with the clinical impact of PAE. METHODS: Magnetic resonance imaging data for patients with a diagnosis of unruptured GIA from the international multicenter Giant Intracranial Aneurysm Registry were retrospectively analyzed with regard to location and size of the GIA, PAE volume, and the presence of PT. The occurrence of PAE was correlated to clinical findings. RESULTS: Imaging data for 69 GIAs were eligible for inclusion in this study. Perianeurysmal edema was observed in 33.3% of all cases, with the highest frequency in GIAs of the middle cerebral artery (MCA; 68.8%) and the lowest frequency in GIAs of the cavernous internal carotid artery (ICA; 0.0%). Independent predictors of PAE formation were GIA volume (OR 1.13, p = 0.02) and the occurrence of PT (OR 9.84, p = 0.04). Giant intracranial aneurysm location did not predict PAE occurrence. Giant aneurysms with PAE were larger than GIAs without PAE (p < 0.01), and GIA volume correlated with PAE volume (rs = 0.51, p = 0.01). Perianeurysmal edema had no influence on the modified Rankin Scale score (p = 0.30 or the occurrence of aphasia (p = 0.61) or hemiparesis (p = 0.82). CONCLUSIONS: Perianeurysmal edema was associated with GIA size and the presence of PT. As no PAE was observed in cavernous ICA aneurysms, even though they exerted mass effect on the brain and also displayed PT, the dura mater may serve as a barrier protecting the brain from PAE formation.
OBJECT: The underlying mechanisms causing intracranial perianeurysmal edema (PAE) are still poorly understood. Since PAE is most frequently observed in giant intracranial aneurysms (GIAs), the authors designed a study to examine the occurrence of PAE in relation to the location, size, and partial thrombosis (PT) of GIAs along with the clinical impact of PAE. METHODS: Magnetic resonance imaging data for patients with a diagnosis of unruptured GIA from the international multicenter Giant Intracranial Aneurysm Registry were retrospectively analyzed with regard to location and size of the GIA, PAE volume, and the presence of PT. The occurrence of PAE was correlated to clinical findings. RESULTS: Imaging data for 69 GIAs were eligible for inclusion in this study. Perianeurysmal edema was observed in 33.3% of all cases, with the highest frequency in GIAs of the middle cerebral artery (MCA; 68.8%) and the lowest frequency in GIAs of the cavernous internal carotid artery (ICA; 0.0%). Independent predictors of PAE formation were GIA volume (OR 1.13, p = 0.02) and the occurrence of PT (OR 9.84, p = 0.04). Giant intracranial aneurysm location did not predict PAE occurrence. Giant aneurysms with PAE were larger than GIAs without PAE (p < 0.01), and GIA volume correlated with PAE volume (rs = 0.51, p = 0.01). Perianeurysmal edema had no influence on the modified Rankin Scale score (p = 0.30 or the occurrence of aphasia (p = 0.61) or hemiparesis (p = 0.82). CONCLUSIONS:Perianeurysmal edema was associated with GIA size and the presence of PT. As no PAE was observed in cavernous ICA aneurysms, even though they exerted mass effect on the brain and also displayed PT, the dura mater may serve as a barrier protecting the brain from PAE formation.
Authors: Alba Scerrati; Giovanni Sabatino; Giuseppe Maria Della Pepa; Alessio Albanese; Enrico Marchese; Alfredo Puca; Alessandro Olivi; Carmelo Lucio Sturiale Journal: Neurosurg Rev Date: 2018-05-22 Impact factor: 3.042
Authors: T Sato; T Matsushige; B Chen; O Gembruch; P Dammann; R Jabbarli; M Forsting; A Junker; S Maderwald; H H Quick; M E Ladd; U Sure; K H Wrede Journal: AJNR Am J Neuroradiol Date: 2019-05-30 Impact factor: 3.825
Authors: Guilherme Brasileiro de Aguiar; Mário Vítor Caldeira Pagotto; Mario Luiz Marques Conti; José Carlos Esteves Veiga Journal: Surg Neurol Int Date: 2016-02-08