Advertisement

Clinical Neuroradiology

, Volume 29, Issue 4, pp 717–723 | Cite as

Growth of Asymptomatic Intracranial Fusiform Aneurysms

Incidence and Risk Factors
  • Jusun Moon
  • Young Dae ChoEmail author
  • Dong Hyun Yoo
  • Jeongjun Lee
  • Hyun-Seung Kang
  • Won-Sang Cho
  • Jeong Eun Kim
  • Li Zhang
  • Moon Hee Han
Original Article

Abstract

Purpose

Growth of intracranial fusiform aneurysms (IFA) may become clinically problematic through a mass effect or rupture. We investigated the growth rate and factors contributing to growth in asymptomatic untreated IFA.

Method

As a retrospective review, we assessed patients diagnosed with asymptomatic IFA between August 2000 and September 2014, all untreated. No acute or symptomatic dissecting lesions were considered. Clinical and serial angiographic follow-up data were analyzed, defining growth as expansion > 2 mm in one or more dimensions. A binary logistic regression model and Kaplan-Meier method were applied for statistical analysis.

Results

The mean follow-up in the 82 eligible patients was 47.7 months (range 12–190 months). Among them, 7 aneurysms (8.5%, 2.1% per aneurysm year) demonstrated growth (in any dimension). In univariate analysis, height and multiplicity of aneurysms emerged as significant factors in terms of growth. Height remained an independent risk factor in the binary logistic regression model, with receiver operating curves indicating a threshold of 6.9 mm initial height in determining IFA growth (area under the curve 0.804). Of the patients six (except one who underwent endovascular treatment) were observed during continued follow-up monitoring. All six lesions were stable in serial imaging tests, without further detectable growth or rupture (mean 33 months).

Conclusion

Most (91.5%) of the asymptomatic and untreated IFAs studied proved to be stable, with no continued growth; however, because aneurysm height proved to be independently predictive of growth (lesions > 6.9 mm being at risk), periodic imaging is required in those left untreated. Growing but still asymptomatic aneurysms call for the utmost caution and care in decision-making.

Keywords

Aneurysm Fusiform Unruptured Growth Follow-up 

Notes

Compliance with ethical guidelines

Conflict of interest

J. Moon, Y.D. Cho, D.H. Yoo, J. Lee, H.-S. Kang, W.-S. Cho, J.E. Kim, L. Zhang and M.H. Han declare that they have no competing interests.

Ethical standards

This study complied with the principles outlined in the Declaration of Helsinki and was approved by our institutional review board (Seoul National University Hospital).

Supplementary material

62_2018_695_MOESM1_ESM.docx (16 kb)
SUPPLEMENTAL TABLE 1. Location of intracranial fusiform aneurysms (n = 82)

References

  1. 1.
    Li MH, Chen SW, Li YD, Chen YC, Cheng YS, Hu DJ et al. Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years: a cross-sectional study. Ann Intern Med. 2013;159:514–21.CrossRefGoogle Scholar
  2. 2.
    Vlak MH, Algra A, Brandenburg R, Rinkel GJ. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol. 2011;10:626–36.CrossRefGoogle Scholar
  3. 3.
    Rinkel GJ. Natural history, epidemiology and screening of unruptured intracranial aneurysms. Rev Neurol. 2008;164:781–6.CrossRefGoogle Scholar
  4. 4.
    Ziemba-Davis M, Bohnstedt BN, Payner TD, Leipzig TJ, Palmer E, Cohen-Gadol AA. Incidence, epidemiology, and treatment of aneurysmal subarachnoid hemorrhage in 12 midwest communities. J Stroke Cerebrovasc Dis. 2014;23:1073–82.CrossRefGoogle Scholar
  5. 5.
    Brinjikji W, Zhu YQ, Lanzino G, Cloft HJ, Murad MH, Wang Z et al. Risk factors for growth of Intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2016;37:615–20.CrossRefGoogle Scholar
  6. 6.
    Mehan WA Jr, Romero JM, Hirsch JA, Sabbag DJ, Gonzalez RG, Heit JJ et al. Unruptured intracranial aneurysms conservatively followed with serial CT angiography: could morphology and growth predict rupture? J Neurointerv Surg. 2014;6:761–6.CrossRefGoogle Scholar
  7. 7.
    Choi HH, Cho YD, Jeon JP, Yoo DH, Moon J, Lee J et al. Growth of untreated unruptured small-sized aneurysms ( precedes7mm): incidence and related factors. Clin Neuroradiol. 2017 Feb 1.  https://doi.org/10.1007/s00062-017-0559-y. [Epub ahead of print].CrossRefPubMedGoogle Scholar
  8. 8.
    Burns JD, Huston J 3rd, Layton KF, Piepgras DG, Brown RD Jr.. Intracranial aneurysm enlargement on serial magnetic resonance angiography: frequency and risk factors. Stroke. 2009;40:406–11.CrossRefGoogle Scholar
  9. 9.
    Chien A, Liang F, Sayre J, Salamon N, Villablanca P, Viñuela F. Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms. J Neurosurg. 2013;119:190–7.CrossRefGoogle Scholar
  10. 10.
    Matsubara S, Hadeishi H, Suzuki A, Yasui N, Nishimura H. Incidence and risk factors for the growth of unruptured cerebral aneurysms: observation using serial computerized tomography angiography. J Neurosurg. 2004;101:908–14.CrossRefGoogle Scholar
  11. 11.
    Matsumoto K, Oshino S, Sasaki M, Tsuruzono K, Taketsuna S, Yoshimine T. Incidence of growth and rupture of unruptured intracranial aneurysms followed by serial MRA. Acta Neurochir (Wien). 2013;155:211–6.CrossRefGoogle Scholar
  12. 12.
    Miyazawa N, Akiyama I, Yamagata Z. Risk factors for growth of unruptured intracranial aneurysms: follow-up study by serial 0.5-T magnetic resonance angiography. Neurosurgery. 2006;58:1047–53.CrossRefGoogle Scholar
  13. 13.
    Passero SG, Rossi S. Natural history of vertebrobasilar dolichoectasia. Neurology. 2008;70:66–72.CrossRefGoogle Scholar
  14. 14.
    Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Nakatomi H, Huston J 3rd et al. Prospective risk of hemorrhage in patients with vertebrobasilar nonsaccular intracranial aneurysm. J Neurosurg. 2004;101:82–7.CrossRefGoogle Scholar
  15. 15.
    Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Huston J 3rd, McClelland RL, Christianson TJ. The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovasc Dis. 2005;20:270–9.CrossRefGoogle Scholar
  16. 16.
    Mangrum WI, Huston J 3rd, Link MJ, Wiebers DO, McClelland RL, Christianson TJ et al. Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth. J Neurosurg. 2005;102:72–9.CrossRefGoogle Scholar
  17. 17.
    Shapiro M, Becske T, Riina HA, Raz E, Zumofen D, Nelson PK. Non-saccular vertebrobasilar aneurysms and dolichoectasia: a systematic literature review. J Neurointerv Surg. 2014;6:389–93.CrossRefGoogle Scholar
  18. 18.
    Anson JA, Lawton MT, Spetzler RF. Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg. 1996;84:185–93.CrossRefGoogle Scholar
  19. 19.
    Drake CG, Peerless SJ. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg. 1997;87:141–62.CrossRefGoogle Scholar
  20. 20.
    Day AL, Gaposchkin CG, Yu CJ, Rivet DJ, Dacey RG Jr.. Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg. 2003;99:228–40.CrossRefGoogle Scholar
  21. 21.
    Sacho RH, Saliou G, Kostynskyy A, Menezes R, Tymianski M, Krings T et al. Natural history and outcome after treatment of unruptured intradural fusiform aneurysms. Stroke. 2014;45:3251–6.CrossRefGoogle Scholar
  22. 22.
    van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001;124:249–78.CrossRefGoogle Scholar
  23. 23.
    Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H et al. Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke. 2000;31:896–900.CrossRefGoogle Scholar
  24. 24.
    Kobayashi N, Murayama Y, Yuki I, Ishibashi T, Ebara M, Arakawa H et al. Natural course of dissecting vertebrobasilar artery aneurysms without stroke. AJNR Am J Neuroradiol. 2014;35:1371–5.CrossRefGoogle Scholar
  25. 25.
    Mizutani T, Miki Y, Kojima H, Suzuki H. Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery. 1999;45:253–60.CrossRefGoogle Scholar
  26. 26.
    Yasui T, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M, Morikawa T. Evolution of incidentally-discovered fusiform aneurysms of the vertebrobasilar arterial system: neuroimaging features suggesting progressive aneurysm growth. Neurol Med Chir (Tokyo). 2001;41:523–8.CrossRefGoogle Scholar
  27. 27.
    Bhogal P, Pérez MA, Ganslandt O, Bäzner H, Henkes H, Fischer S. Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-center experience and review of 56 patients. J Neurointerv Surg. 2017;9:471–81.CrossRefGoogle Scholar
  28. 28.
    Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103–10.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jusun Moon
    • 1
  • Young Dae Cho
    • 2
    Email author
  • Dong Hyun Yoo
    • 2
  • Jeongjun Lee
    • 2
  • Hyun-Seung Kang
    • 3
  • Won-Sang Cho
    • 3
  • Jeong Eun Kim
    • 3
  • Li Zhang
    • 4
  • Moon Hee Han
    • 2
    • 3
  1. 1.Department of Neurology, Korea University Anam HospitalKorea University College of MedicineSeoulKorea (Republic of)
  2. 2.Department of Radiology, Seoul National University HospitalSeoul National University College of MedicineSeoulKorea (Republic of)
  3. 3.Department of Neurosurgery, Seoul National University HospitalSeoul National University College of MedicineSeoulKorea (Republic of)
  4. 4.Department of NeurologyChina-Japan Union Hospital of Jilin UniversityChangchunChina

Personalised recommendations