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The influence of aneurysm morphology on the volume of hemorrhage after rupture

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Date
2021-09-17
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Authors
Munarriz, Pablo M. ; Navarro Main, Blanca ; Alén, José F. ; Jiménez Roldán, Luis ; Castaño León, Ana María ; Moreno Gómez, Luis Miguel ; Paredes, Igor ; García Pérez, Daniel ; Panero, Irene ; Eiriz Fernández, Carla ; Esteban Sinovas, Olga ; Bárcena, Eduardo ; Gómez, Pedro A. ; Lagares, Alfonso
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Facultades de la UMU::Facultad de Medicina
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Publisher
American Association of Neurological Surgeons (AANS)
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Farmacología
DOI
https://doi.org/10.3171/2021.3.JNS21293
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info:eu-repo/semantics/article
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Abstract
OBJECTIVE Factors determining the risk of rupture of intracranial aneurysms have been extensively studied; however, little attention is paid to variables influencing the volume of bleeding after rupture. In this study the authors aimed to evaluate the impact of aneurysm morphological variables on the amount of hemorrhage. METHODS This was a retrospective cohort analysis of a prospectively collected data set of 116 patients presenting at a single center with subarachnoid hemorrhage due to aneurysmal rupture. A volumetric assessment of the total hemorrhage volume was performed from the initial noncontrast CT. Aneurysms were segmented and reproduced from the initial CT angiography study, and morphology indexes were calculated with a computer-assisted approach. Clinical and demographic characteristics of the patients were included in the study. Factors influencing the volume of hemorrhage were explored with univariate correlations, multiple linear regression analysis, and graphical probabilistic modeling. RESULTS The univariate analysis demonstrated that several of the morphological variables but only the patient’s age from the clinical-demographic variables correlated (p < 0.05) with the volume of bleeding. Nine morphological variables correlated positively (absolute height, perpendicular height, maximum width, sac surface area, sac volume, size ratio, bottleneck factor, neck-to-vessel ratio, and width-to-vessel ratio) and two correlated negatively (parent vessel average diameter and the aneurysm angle). After multivariate analysis, only the aneurysm size ratio (p < 0.001) and the patient’s age (p = 0.023) remained statistically significant. The graphical probabilistic model confirmed the size ratio and the patient’s age as the variables most related to the total hemorrhage volume. CONCLUSIONS A greater aneurysm size ratio and an older patient age are likely to entail a greater volume of bleeding after subarachnoid hemorrhage.
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Subarachnoid hemorrhage , Computational geometry , Image segmentation , Volumetric analysis , Aneurysm morphology , Vascular disorder , Intracranial aneurysm
Citation
Journal of Neurosurgery, 2022, Vol. 136, Issue 4, pp. 1015–1023
URI
http://hdl.handle.net/10201/208682
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