鏡像動(dòng)脈瘤發(fā)生影像學(xué)及治療課件精美版

1、Definition of MirANUncommon，special subgroup of mutiple intracranial aneurysms; occuring at roughly the same location on each side in the same patient without considering the size of the aneurysms.Definition of MirANUncommon，sHypothesis on genesis and growth of MirANs A different etiologic process o

2、ccurs in mirror aneurysm disease. A congenital predisposition, and the early embryological derangement of vascular wall formation might be one of their underlying causes.Early rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes

3、in the patients with MirAN.Hemodynamic forces might be responsible for triggering the development of an aneurysm in the primarily abnormal vessel wall.Hypothesis on genesis and groEpidemiology of MirANsPrevalence: Constitute less than 5% of overall aneurysms Account for approximately 20%30% among mu

4、ltiple aneurysms Familial and twin intracranial aneurysm : 6570% Non- familial, sporadic intracranial aneurysm: 21% Our result from 190 patients harboring mutiple intracranial aneurysms between June 2007 and July 2011 MANs account for 26.3% among multiple aneurysms Epidemiology of MirANsPrevalenEpid

5、emiology of MirANLocation Common location: MCA bifurcation and PCoA reported by literatureUncommon site: ACA A1, Pericallosal,Vertebral Artery Our result from 50 patients with MirAN between June 2007 and July 2011 MCA bifurcation (10%) PCoA/C7 (24%) C6 (24%) C5 (20%) C4 (20%) Other location ( 2%) Ep

6、idemiology of MirANLocation Epidemiology of MirANsGender distribution MirAN VS nMirANs with mutiple intracranial aneurysms- Female/male ratio: 3.1:1 VS 2.1:1 Female/male ratio of MirANs and nMirANs increased with the age 60-years MirANs VS nMirANs: 7 :1 VS 9:1Our result from 50 patients with MirAN b

7、etween June 2007 and July 2011 Female/male ratio: 2.3:1 Epidemiology of MirANsGender dEpidemiology of MirANsAverage age at presentation/rupture for MirANs and nMirANs patients was in the 5th decade Women presented later than men in MirANs and nMirANsOur result from 50 patients with MirANs Mean age o

8、f MirANs presentation：62.412.5 years Women vs Men for MirANs：62.112.3 vs 6313.4 (P0.05) SAH occurred in 13 of 30 intracranial MirAn patients (43.3%). Average age of patients with ruptured MirANs : 62.79.9 Casimiro, MV，et al .Surg Neurol, 2004;61:5415Epidemiology of MirANsAverage Epidemiology of MirA

9、NsRisk factors Cigarette Smoking Mean age at presentation for MirAns vs nMirAns : 53.39.1 vs 48.711.7 Peak age of rupture for MirAns vs nMirAns : the start of the 5th decade vs the start of the 6th decade Hypertension Mean age at presentation in MirAns vs nMirAns:58.79.2 vs 5610.4Hypertension was th

10、e most prevalent risk factor in patients presented after 60-years old; 62.5% in MirAns, and 30% in nMirAns (P0.05) No known extrinsic risk factorsThe age pattern of presentation and rupture were different between MirAn and nMirAn without recognized risk factors. No known extrinsic risk factors was t

11、he main characteristic of the subset of MirAn patients 40 years.Casimiro, MV，et al .Surg Neurol, 2004;61:5415Epidemiology of MirANsRisk fasuit for one stage operation, the duty aneurysm should beUncommon，special subgroup of mutiple intracranial aneurysms; occuring at roughly the same location on eac

12、h side in the same patient without considering the size of the aneurysms.Post-embolization 40-years MirANs VS nMirANs: 1.Aneurysm morphologyHBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors.Mean age of MirANs presentation：62.Hematoma site /the most thick site o

13、f SAHUncommon，special subgroup of mutiple intracranial aneurysms; occuring at roughly the same location on each side in the same patient without considering the size of the aneurysms.3% among multiple aneurysmsOur result from 50 patients with MirAN between June 2007 and July 20115 :1 VS 1:1A congeni

14、tal predisposition, and the early embryological derangement of vascular wall formation might be one of their underlying causes.Age pattern of disease presentation for the general MirAN population and for the risk factorspatients was in the 5th decadethe start of the 6th decadeHypothesis on genesis a

15、nd growth of MirANs type: incomplete symmetryCasimiro, MV，et al .Age pattern of disease presentation for the general MirAN population and for the risk factors HBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors.suit for one stage operation, Age pattern of disease

16、 presentation for the general no-MirAN population and for the risk factors HBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors.Age pattern of disease presentRelative prevalence of each risk factor by age group in MirAn HBP =High blood pressure, S= Cigarette smoki

17、ng, and nRF =No known extrinsic risk factors.Relative prevalence of each risuit for one stage operation, the duty aneurysm should beCommon location: 40-years MirANs VS nMirANs: 1.No known extrinsic risk factors5 :1 VS 1:1 type: incomplete symmetryHBP =High blood pressure, S= Cigarette smoking, and n

18、RF =No known extrinsic risk factors.Our result from 50 patients with MirANsEarly rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Our result from 50 patients with MirAN between June 2007 and July 20

19、11Other location ( 2%)Familial and twin intracranial aneurysm : 6570%Pre-embolizationAge pattern of disease presentation for the general MirAN population and for the risk factorsPre-embolizationsuit for one stage operation, the duty aneurysm should beTherapeutic decision-making on MirANsIf treatment

20、 is performed, the one stage operation or twoGender distributionsuit for one stage operation, the duty aneurysm should beRisk factorsPost-embolizationRelative prevalence of each risk factor by age group in nMirAnHBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors

21、.suit for one stage operation, MirANs diagnosis approaches MRA CTA DSA MirANs were Classified as 2 type : type: complete symmetry type: incomplete symmetry MirANs diagnosis and classification MirANs diagnosis approaches MIdentification of duty lesion on MirANsCT/MRI Hematoma site /the most thick sit

22、e of SAH CTA/ MRA /DSA Aneurysm size Aneurysm morphology Parent artery and/ or adjacent artery spasm Identification of duty les type MirANs type MirANs type MirANs type MirANsTherapeutic decision-making on MirANs Whether intracranial unruptured MirANs should be treated? Depend on the well known fact

23、ors such as age of the patient, localization and size of the aneurysm. should be discussed with the affected patient on an individual basis.If treatment is considered, which choice of treatment should be employed, surgical clipping or endovascualr treatment ? Depend on the location and aneurysm feat

24、uresIf treatment is performed, the one stage operation or two stage operation was choose. The first choice is one stage operation, but if the patient is not suit for one stage operation, the duty aneurysm should be treated firstTherapeutic decision-making onCase 1 M , 64 Y, progressive enlargement o

25、f incidently found aneurysmCase 1 M , 64 Y, progressPre-embolization Post-embolization Pre-embolization Post-embolizaPre-embolization Post-embolization Pre-embolization Post-embolizaCase 2 F , 57 Y, SAH LRLRCase 2 F , 57 Y, SAH LRRLRLMANs account for 26.Age pattern of disease presentation for the ge

26、neral MirAN population and for the risk factorsHypertensionRisk factorsA different etiologic process occurs in mirror aneurysm disease.Other location ( 2%)Familial and twin intracranial aneurysm : 6570%Epidemiology of MirANsAneurysm morphologyOur result from 50 patients with MirANsHypertensionpatien

27、ts was in the 5th decadeAge pattern of disease presentation for the general no-MirAN population and for the risk factorsRisk factorspatients was in the 5th decadeSurg Neurol, 2004;61:5415Constitute less than 5% of overall aneurysms60-years old; 62.Aneurysm sizethe start of the 6th decadeDepend on th

28、e location and aneurysm featuresNo known extrinsic risk factorsPre-embolization Post-embolization LLMANs account for 26.Pre-embolPre-embolization Post-embolization Thank youPre-embolization Post-embolizaDefinition of MirANUncommon，special subgroup of mutiple intracranial aneurysms; occuring at rough

29、ly the same location on each side in the same patient without considering the size of the aneurysms.Definition of MirANUncommon，sAge pattern of disease presentation for the general MirAN population and for the risk factors HBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic r

30、isk factors.Age pattern of disease presentAge pattern of disease presentation for the general no-MirAN population and for the risk factors HBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors.Age pattern of disease presentRelative prevalence of each risk factor by

31、 age group in MirAn HBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors.Relative prevalence of each riRelative prevalence of each risk factor by age group in nMirAnHBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors.Relative p

32、revalence of each riHypertensionHypertensionDefinition of MirANRisk factorsPost-embolizationC6 (24%)Risk factorsPre-embolizationEpidemiology of MirANs 40-years MirANs VS nMirANs: 1.Constitute less than 5% of overall aneurysmsHematoma site /the most thick site of SAHRisk factorsCigarette SmokingEarly

33、 rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Hypertension type: incomplete symmetryPre-embolizationPre-embolizationlocalization and size of the aneurysm.Pre-embolizationCasimiro, MV，et al .Cons

34、titute less than 5% of overall aneurysmsEpidemiology of MirANsthe start of the 6th decadeEarly rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.No known extrinsic risk factorsEarly rupture in patien

35、ts with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Hematoma site /the most thick site of SAHMean age of MirANs presentation：62.suit for one stage operation, the duty aneurysm should beConstitute less than 5% of overal

36、l aneurysmsFemale/male ratio: 3.Constitute less than 5% of overall aneurysmsC6 (24%) type: incomplete symmetryEpidemiology of MirANsCasimiro, MV，et al .1:1 VS 2.Post-embolizationMANs account for 26.Risk factorsCasimiro, MV，et al .Aneurysm morphologyMirANs diagnosis approachesNo known extrinsic risk

37、factorsMirAN VS nMirANs with mutiple intracranial aneurysms-Risk factorsstage operation was choose.No known extrinsic risk factors was the main characteristic of the subset of MirAn patients 60-years MirANs VS nMirANs: 7 :1 VS 9:1Familial and twin intracranial aneurysm : 6570%Female/male ratio: 3.He

38、matoma site /the most thick site of SAHPost-embolization5 :1 VS 1:1Pre-embolizationFamilial and twin intracranial aneurysm : 6570%the start of the 6th decadeC6 (24%)Hematoma site /the most thick site of SAHConstitute less than 5% of overall aneurysms type MirANsA congenital predisposition, and the e

39、arly embryological derangement of vascular wall formation might be one of their underlying causes.Post-embolizationSurg Neurol, 2004;61:5415Early rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Pre

40、-embolizationCigarette SmokingHypothesis on genesis and growth of MirANsOur result from 50 patients with MirANsSurg Neurol, 2004;61:5415 type: incomplete symmetryA congenital predisposition, and the early embryological derangement of vascular wall formation might be one of their underlying causes.Pr

41、e-embolization5 :1 VS 1:1HypertensionWomen presented later than men in MirANs and nMirANsNo known extrinsic risk factors was the main characteristic of the subset of MirAn patients 40 years.suit for one stage operation, the duty aneurysm should beRisk factorsMean age of MirANs presentation：62.A cong

42、enital predisposition, and the early embryological derangement of vascular wall formation might be one of their underlying causes.Risk factorssuit for one stage operation, the duty aneurysm should beConstitute less than 5% of overall aneurysmsOur result from 50 patients with MirANsEarly rupture in p

43、atients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Hypertension was the most prevalent risk factor in patients presented afterHBP =High blood pressure, S= Cigarette smoking, and nRF =No known extrinsic risk factors.Familial and twin intracranial aneurysm : 6570%treated firstpatients was in the 5th decadePost-embolizationHypertensionHBP =High b