Cerebral Aneurysms Differ in Patients with Hysterectomies

Abstract

Female sex is a well-known risk factor for aneurysm formation. Although the role of the ovaries and estrogen in aneurysm development has been supported, other organ-hormone pairs unique between sexes also may be implicated. In this study, we aimed to determine whether intracranial aneurysms microsurgically clipped in patients with previous hysterectomies exhibit any uniqueaneurysm characteristics from those without hysterectomies. Solitary aneurysms microsurgically treated by the senior author (M.T.L.) were included from a database of patients treated between January 2010 and April 2013 at a tertiary academic medical center. Only female patients and patients equal or older in age to the youngest patient in the hysterectomy group were included in the control group. Patient and aneurysm characteristics were compared using the χ2 test for categorical variables and the independent t test analysis for continuous variables. A total 233 patients were included in the study. Forty-three patients (19%) had undergone a previous hysterectomy; none had oophorectomies recorded. No difference in mean age (P= 0.89), hypertension (P= 0.38), alcohol use (P= 0.87), tobacco use (P= 0.22), or aneurysm location (P= 1) existed. However, patients in the hysterectomy group more often presented in a good neurologic condition before surgery (88% vs. 74%, P=0.04) and had fewer large aneurysms (8% vs. 24%, P=0.03). Also, fewer presented with a ruptured aneurysm (28%) then the nonhysterectomy group (51%) (P= 0.004). Female patients with a surgical history of a hysterectomy have a lower rate of large aneurysms, present in better neurologic condition, and are less likely to present with a ruptured aneurysm than females without a hysterectomy.