Vergleichende Analyse der Morphologie von intrakraniellen Aneurysmen

Intracranial aneurysms present a complex medical challenge due to their potential to cause life-threatening hemorrhages if ruptured. In this study, we investigated the morphology of ruptured intracranial aneurysms and the influence of risk factors on aneurysm location and morphology.

We analyzed aneurysm height and aneurysm width of ruptured aneurysms in consecutive patients with acute subarachnoid hemorrhage who were treated at our tertiary care center between 2010 and 2020. Additionally, vascular risk factors such as hypertension, diabetes, or nicotine use and their influence on aneurysm location were evaluated.

Among 637 ruptured aneurysms, the most common locations were the anterior communicating artery (AComA) in 29.0%, the middle cerebral artery (MCA) in 27.6%, the posterior communicating artery (PComA) in 11.2%, the supra-ophthalmic part of the internal carotid artery (ICA) in 10.9%, and the basilar artery in 6.0%. The average size (height x width) of the ruptured aneurysms varied between the vessels. The largest ruptured aneurysms were seen at the basilar artery (meadian/mean?7.6x8.9mm), while the smallest ruptured aneurysms were seen at the anterior choroidal artery(3.8x3.6mm). Ruptured aneurysms of the MCA had a median size of 6.3x6.8mm, while aneurysms at the AComA measured 4.9x6.3mm. At the PComA, the aneurysms had a median size of 5.1x6.31mm.

ANOVA analysis revealed a correlation between aneurysm location and Hunt and Hess (H&H) grade. In 63.3% of MCA aneurysms, H&H grades 4 and 5 hemorrhages were seen (p=0.04). In 66% of aneurysms of the PComA, H&H hemorrhages of grades 1-3 were observed (p=0.038). For all other aneurysms, no correlation between H&H grade and aneurysm location was found.

In aneurysms of the posterior inferior cerebellar artery, 72% were associated with Fisher grade 4 hemorrhages (p<0.001), while Fisher grades 1-3 hemorrhages were significantly more common in PComA aneurysms, observed in 82.1% of cases (p<0.001).

No correlation could be found between hypertension, diabetes, nicotine abuse, or coronary heart disease and a specific aneurysm location.

This study highlights significant variations in size and location of ruptured intracranial aneurysms, with notable correlations to H&H grades in specific areas. No association was found between vascular risk factors and aneurysm location, emphasizing the need to focus on anatomical aspects in their treatment and management.