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1、,Genesis,Imaging and Treatment of Intracranial Mirror Aneurysms(MirANs),Institute of Diagnostic and Interventional Radiology,The Sixth Affiliated Peoples Hospital,Shanghai Jiao Tong University,TAN HUA-QIAO MD.Ph.D.,Definition of MirAN,Uncommon，special subgroup of mutiple intracranial aneurysms;occur
2、ing at roughly the same location on each side in the same patient without considering the size of the aneurysms.,Hypothesis on genesis and growth of MirANs,A different etiologic process occurs in mirror aneurysm disease.A congenital predisposition,and the early embryological derangement of vascular
3、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 in the patients with MirAN.Hemodynamic forces might be responsible for triggering the development of an aneurysm in
4、 the primarily abnormal vessel wall.,Epidemiology of MirANs,Prevalence:Constitute less than 5%of overall aneurysms Account for approximately 20%30%among multiple aneurysms Familial and twin intracranial aneurysm:6570%Non-familial,sporadic intracranial aneurysm:21%Our result from 190 patients harbori
5、ng mutiple intracranial aneurysms between June 2007 and July 2011 MANs account for 26.3%among multiple aneurysms,Epidemiology of MirAN,Location Common location:MCA bifurcation and PCoA reported by literatureUncommon site:ACA A1,Pericallosal,Vertebral Artery Our result from 50 patients with MirAN bet
6、ween June 2007 and July 2011 MCA bifurcation(10%)PCoA/C7(24%)C6(24%)C5(20%)C4(20%)Other location(2%),Epidemiology of MirANs,Gender 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-year
7、s MirANs VS nMirANs:7:1 VS 9:1Our result from 50 patients with MirAN between June 2007 and July 2011 Female/male ratio:2.3:1,Epidemiology of MirANs,Average age at presentation/rupture for MirANs and nMirANs patients was in the 5th decade Women presented later than men in MirANs and nMirANsOur result
8、 from 50 patients with MirANs Mean age of 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;61:5415,Epidemiology of Mi
9、rANs,Risk 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 the
10、 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 the main
11、characteristic of the subset of MirAn patients 40 years.,Casimiro,MV，et al.Surg Neurol,2004;61:5415,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.,Age pattern of diseas
12、e 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.,Relative prevalence of each risk factor by age group in MirAn,HBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk f
13、actors.,Relative prevalence of each risk factor by age group in nMirAn,HBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.,MirANs diagnosis approaches MRA CTA DSA MirANs were Classified as 2 type:type:complete symmetry type:incomplete symmetry,MirANs diagnosis and cl
14、assification,Identification of duty lesion on MirANs,CT/MRI Hematoma site/the most thick site of SAH CTA/MRA/DSA Aneurysm size Aneurysm morphology Parent artery and/or adjacent artery spasm,type MirANs,type MirANs,Therapeutic decision-making on MirANs,Whether intracranial unruptured MirANs should be
15、 treated?,Depend on the well known factors 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
16、 on the location and aneurysm features,If 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 first,Case 1 M,64 Y,progressive enlargement of incidently found aneurysm,Pre-embolization,Post-embolization,Pre-embolization,Post-embolization,Case 2 F,57 Y,SAH,L,R,L,R,R,L,Pre-embolization,Post-embolization,L,L,Pre-embolization,Post-embolization,Thank you,
