Abstract
BackgroundPatients with multiple intracranial aneurysms present a great challenge to the neurosurgeon, particularly when presenting with subarachnoid hemorrhage. Misjudgment may result in disastrous postoperative rebleeding from the untreated but true-ruptured lesion.MethodsIn this study, computational fluid dynamic simulations of two matched-pairs of ruptured–unruptured cerebral aneurysms were performed to investigate the potential association between flow instability and aneurysm rupture. Two pairs of cerebral aneurysms from two patients were located in the middle cerebral artery and the anterior communicating artery respectively.ResultsOur results demonstrated highly disturbed states of the blood flows in the ruptured aneurysms of the two patients with multiple aneurysms, which are characterized by remarked velocity and wall shear stress (WSS) fluctuations at late systole. The ruptured aneurysms exhibit obviously temporal intra-cycle WSS fluctuations rather than the unruptured aneurysms of the same patient. Cycle-to-cycle fluctuations are further observed in the ruptured aneurysms when the flow turns to decelerate.ConclusionsThe obvious differences observed between matched-pairs of ruptured–unruptured aneurysms imply that flow instability may be a potential source correlating to aneurysm rupture.
Highlights
Patients with multiple intracranial aneurysms present a great challenge to the neurosurgeon, when presenting with subarachnoid hemorrhage
The local stagnation regions inside the aneurysm obviously correspond to low wall shear stress (WSS) and high oscillatory shear index (OSI) surrounded by high WSS regions
With a unique patient-specific model of two matched-pairs of rupture-unruptured cerebral aneurysms we demonstrated that the two ruptured aneurysms apparently present stronger WSS fluctuations compared with the unruptured aneurysms in the same patient
Summary
Patients with multiple intracranial aneurysms present a great challenge to the neurosurgeon, when presenting with subarachnoid hemorrhage. Misjudgment may result in disastrous postoperative rebleeding from the untreated but true-ruptured lesion. Cerebral aneurysms are cerebrovascular protruding sacs that develop in specific cerebrovascular sites. The most severe consequence of cerebral aneurysm is its rupture and intracranial subarachnoid hemorrhage (SAH), causing a high mortality rate. Multiple intracranial aneurysms are observed in 15–35% of patients with aneurysms who present with SAH [1,2,3]. For SAH patients with multiple aneurysms, it is very important for a medical team to determine which one causes SAH. Misdiagnosis is dangerous because the untreated but ruptured aneurysm may re-rupture soon [4, 5].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
