Морфометриски карактеристики на аневризмите како предикторни фактори за нивна руптура

Abstract

Intracranial aneurysms represent an abnormal expansion of the brain vessels. The incidence of intracranial aneurysms in the adult population is between 2 to 6%. If the aneurysms are left untreated, they will grow, which will lead to rupture of the aneurysm and bleeding in the brain parenchyma, subdural bleeding or subarachnoid haemorrhage. These conditions are characterized by a high rate of mortality and disability. The significance of aneurysms is based on the fact that they occupy a significant part of the population and, if they grow, that will lead to rupture of the aneurysm and subarachnoid haemorrhage, which is a life-threatening condition. If we take these facts into consideration, it is obvious that there is a need for excellent knowledge of all aspects of intracranial aneurysms. Aim of the study: The aim of this study was to investigate the morphometric characteristics of the aneurysms in terms of localization, shape of aneurysms, dimensions of the aneurysms, and to determine the geometric indexes of aneurysms. Based on these parameters, we will be able to determine the risk for rupture of aneurysms and choose the best therapeutic modality for the treatment of aneurysms. Material and Methods: The study included a representative sample of 107 patients of both sexes over the age of 18 years. The patients were divided into two groups. The study group consisted of 74 patients with ruptured aneurysm of the brain vessels. The control group consisted of 33 patients with unruptured aneurysm of the brain vessels. Results: In both the examined and the control group of patients aneurysms of the anterior brain circulation were predominantly present; they were found in 87.84% of patients in the examined group and in 84.85% of patients in the control group. Aneurysms of the posterior brain circulation were found in 12.16% of patients in the examined group and in 15.15% of patients in the control group. The presence of one aneurysm was diagnosed in 75.57% of patients in the examined group, while in the control group one aneurysm occurred in 81.82% of patients. Multiple aneurysms occurred in 24.32% of patients in the examined group and in 18.18% of patients in the examined group. According to the form aneurysms were divided into three groups; sacral aneurysms were predominant and they occurred in 87.84% of patients in the examined group, and in 81.82% of patients in the control group. The mean diameter of the ruptured intracranial aneurysms was 7.04 ± 3.06 mm, while in the unruptured aneurysms 4.02 ± 1.10 mm. The mean neck width of ruptured intracranial aneurysms was 3.32 ± 0.91 mm vs. 2.66 - 0.63 mm in the group with unruptured aneurysms. The mean value of height in ruptured intracranial aneurysms was 6.37 ± 1.27 mm vs. 4.2 ± 1.06 mm in unruptured aneurysms. The mean AR value was 1.99 ± 0.38 in ruptured aneurysms, while 1.58 ± 0.23 in unruptured aneurysms. In 81.08% of patients with ruptured aneurysm, the AR value was greater than 1.8. The mean registered value of OR in ruptured intracranial aneurysms in this series was 1.47 ± 0.53 vs. 0.87 ± 0.27 in unruptured aneurysms. The mean SR in ruptured intracranial aneurysms was 2.59 ± 0.99, while in unruptured aneurysms 1.36 ± 0.31. In 71.62% of patients, the SR value was greater than 2.05. The mean registered value of BNF of ruptured intracranial aneurysms was 2.13 ± 0.71 vs. 1.51 ± 0.24 in the control group with unruptured aneurysms. Conclusion: Through knowledge of the morphometric characteristics of intracranial aneurysms is necessary, because on the basis of the morphometric characteristics of the aneurysms we can determine the risk of aneurysm rupture and to carry out elective treatment of unruptured aneurysms. Factors that increase the risk of rupture of aneurysms include: age of patients, diameter of aneurysm, height of aneurysms and geometric indices such as AR, OR and SR. The morphometric characteristics of the aneurysms are very important in planning and implementation of the interventional procedures in neurosurgery.