Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Neurosurgical Review
Erschienen in: Neurosurgical Review 2/2017

24.11.2016 | Case Report

Hemodynamic changes in a middle cerebral artery aneurysm at follow-up times before and after its rupture: a case report and a review of the literature

verfasst von: A. Sejkorová, K. D. Dennis, H. Švihlová, O. Petr, G. Lanzino, A. Hejčl, D. Dragomir-Daescu

Erschienen in: Neurosurgical Review | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Hemodynamic parameters play a significant role in the development of cerebral aneurysms. Parameters such as wall shear stress (WSS) or velocity could change in time and may contribute to aneurysm growth and rupture. However, the hemodynamic changes at the rupture location remain unclear because it is difficult to obtain data prior to rupture. We analyzed a case of a ruptured middle cerebral artery (MCA) aneurysm for which we acquired imaging data at three time points, including at rupture. A patient with an observed MCA aneurysm was admitted to the emergency department with clinical symptoms of a subarachnoid hemorrhage. During three-dimensional (3D) digital subtraction angiography (DSA), the aneurysm ruptured again. Imaging data from two visits before rupture and this 3D DSA images at the moment of rupture were acquired, and computational fluid dynamic (CFD) simulations were performed. Results were used to describe the time-dependent changes of the hemodynamic variables associated with rupture. Time-dependent hemodynamic changes at the rupture location were characterized by decreased WSS and flow velocity magnitude. The impingement jet in the dome changed its position in time and the impingement area at follow-up moved near the rupture location. The results suggest that the increased WSS on the dome and increased low wall shear stress area (LSA) and decreased WSS on the daughter bleb with slower flow and slow vortex may be associated with rupture. CFD performed during the follow-up period may be part of diagnostic tools used to determine the risk of aneurysm rupture.
Literatur
1.
Bor AS, Tiel Groenestege AT, terBrugge KG, Agid R, Velthuis BK, Rinkel GJ, Wermer MJ (2015) Clinical, radiological, and flow-related risk factors for growth of untreated, unruptured intracranial aneurysms. Stroke; a journal of cerebral circulation 46:42–48CrossRef
2.
Boussel L, Rayz V, McCulloch C, Martin A, Acevedo-Bolton G, Lawton M, Higashida R, Smith WS, Young WL, Saloner D (2008) Aneurysm growth occurs at region of low wall shear stress. Patient-Specific Correlation of Hemodynamics and Growth in a Longitudinal Study Stroke 39:2997–3002
3.
Bowker TJ, Watton PN, Summers PE, Byrne JV, Ventikos Y (2010) Rest versus exercise hemodynamics for middle cerebral artery aneurysms: a computational study. AJNR Am J Neuroradiol 31:317–323CrossRefPubMed
4.
Castro MA, Ahumada Olivares MC, Putman CM, Cebral JR (2014) Unsteady wall shear stress analysis from image-based computational fluid dynamic aneurysm models under Newtonian and Casson rheological models. Med Biol Eng Comput 52:827–839CrossRefPubMed
5.
Castro MA, Putman CM, Cebral JR (2006) Computational fluid dynamics modeling of intracranial aneurysms: effects of parent artery segmentation on intra-aneurysmal hemodynamics. AJNR Am J Neuroradiol 27:1703–1709PubMed
6.
Cebral JR, Castro MA, Appanaboyina S, Putman CM, Millan D, Frangi AF (2005) Efficient pipeline for image-based patient-specific analysis of cerebral aneurysm hemodynamics: technique and sensitivity. IEEE Trans Med Imaging 24:457–467CrossRefPubMed
7.
Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM (2005) Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 26:2550–2559PubMed
8.
Cebral JR, Mut F, Weir J, Putman C (2011) Quantitative characterization of the hemodynamic environment in ruptured and unruptured brain aneurysms. AJNR Am J Neuroradiol 32:145–151CrossRefPubMed
9.
Cebral JR, Sheridan M, Putman CM (2010) Hemodynamics and bleb formation in intracranial aneurysms. AJNR Am J Neuroradiol 31:304–310CrossRefPubMed
10.
Chien A, Castro MA, Tateshima S, Sayre J, Cebral J, Vinuela F (2009) Quantitative hemodynamic analysis of brain aneurysms at different locations. AJNR Am J Neuroradiol 30:1507–1512CrossRefPubMed
11.
Chien A, Sayre J (2014) Morphologic and hemodynamic risk factors in ruptured aneurysms imaged before and after rupture. Am J Neuroradiol 35:2130–2135CrossRefPubMed
12.
Cloft HJ, Joseph GJ, Dion JE (1999) Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 30:317–320CrossRefPubMed
13.
Cornelissen BMW, Schneiders JJ, Potters WV, Van Den Berg R, Velthuis BK, Rinkel GJE, Slump CH, VanBavel E, Majoie CBLM, Marquering HA (2015) Hemodynamic differences in intracranial aneurysms before and after rupture. Am J Neuroradiol 36:1927–1933CrossRefPubMed
14.
D’Arcangelo D, Ambrosino V, Giannuzzo M, Gaetano C, Capogrossi MC (2006) Axl receptor activation mediates laminar shear stress anti-apoptotic effects in human endothelial cells. Cardiovasc Res 71:754–763CrossRefPubMed
15.
Dhar S, Tremmel M, Mocco J, Kim M, Yamamoto J, Siddiqui AH, Hopkins LN, Meng H (2008) Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 63:185–197CrossRefPubMedPubMedCentral
16.
Duan G, Lv N, Yin J, Xu J, Hong B, Xu Y, Liu J, Huang Q (2016) Morphological and hemodynamic analysis of posterior communicating artery aneurysms prone to rupture: a matched case-control study. Journal of NeuroInterventional Surgery 8:47–51CrossRefPubMed
17.
Fukazawa K, Ishida F, Umeda Y, Miura Y, Shimosaka S, Matsushima S, Taki W, Suzuki H (2015) Using computational fluid dynamics analysis to characterize local hemodynamic features of middle cerebral artery aneurysm rupture points. World Neurosurg 83:80–86CrossRefPubMed
18.
Geers AJ, Larrabide I, Radaelli AG, Bogunovic H, Kim M, Gratama van Andel HA, Majoie CB, VanBavel E, Frangi AF (2011) Patient-specific computational hemodynamics of intracranial aneurysms from 3d rotational angiography and ct angiography: an in vivo reproducibility study. AJNR Am J Neuroradiol 32:581–586CrossRefPubMed
19.
Goubergrits L, Schaller J, Kertzscher U, van den Bruck N, Poethkow K, Petz C, Hege HC, Spuler A (2012) Statistical wall shear stress maps of ruptured and unruptured middle cerebral artery aneurysms. J R Soc Interface 9:677–688CrossRefPubMed
20.
Grzyska U, Freitag J, Zeumer H (1990) Selective cerebral intraarterial DSA: complication rate and control of risk factors. Neuroradiology 32:296–299CrossRefPubMed
21.
Hassan T, Timofeev EV, Saito T, Shimizu H, Ezura M, Matsumoto Y, Takayama K, Tominaga T, Takahashi A (2005) A proposed parent vessel geometry-based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture.[erratum appears in j neurosurg. 2005 dec;103(6):1110]. J Neurosurg 103:662–680CrossRefPubMed
22.
He X, Ku DN (1996) Pulsatile flow in the human left coronary artery bifurcation: average conditions. J Biomech Eng 118:74–82CrossRefPubMed
23.
Himburg HA, Grzybowski DM, Hazel AL, LaMack JA, Li X-M, Friedman MH (2004) Spatial comparison between wall shear stress measures and porcine arterial endothelial permeability. Am J Physiol Heart Circ Physiol 286:H1916–H1922CrossRefPubMed
24.
Hodis S, Uthamaraj S, Lanzino G, Kallmes DF, Dragomir-Daescu D (2014) Computational fluid dynamics simulation of an anterior communicating artery ruptured during angiography. J Neurointerv Surg 6:e14CrossRefPubMed
25.
Hodis S, Uthamaraj S, Smith AL, Dennis KD, Kallmes DF, Dragomir-Daescu D (2012) Grid convergence errors in hemodynamic solution of patient-specific cerebral aneurysms. J Biomech 45:2907–2913CrossRefPubMed
26.
Investigators TISoUIA (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733CrossRef
27.
Jing L, Fan J, Wang Y, Li H, Wang S, Yang X, Zhang Y (2015) Morphologic and hemodynamic analysis in the patients with multiple intracranial aneurysms: ruptured versus unruptured. PLoS One 10:e0132494CrossRefPubMedPubMedCentral
28.
Jou LD, Lee DH, Morsi H, Mawad ME (2008) Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. AJNR Am J Neuroradiol 29:1761–1767CrossRefPubMed
29.
Kadasi LM, Dent WC, Malek AM (2013) Colocalization of thin-walled dome regions with low hemodynamic wall shear stress in unruptured cerebral aneurysms. J Neurosurg 119:172–179CrossRefPubMed
30.
Li ML, Wang YC, Liou TM, Lin CA (2014) The hemodynamics in intracranial aneurysm ruptured region with active contrast leakage during computed tomography angiography. Comput Mech 54:987–997CrossRef
31.
Li Y-SJ, Haga JH, Chien S (2005) Molecular basis of the effects of shear stress on vascular endothelial cells. J Biomech 38:1949–1971CrossRefPubMed
32.
Liu J, Fan J, Xiang J, Zhang Y, Yang X (2016) Hemodynamic characteristics of large unruptured internal carotid artery aneurysms prior to rupture: a case control study. Journal of Neurointerventional Surgery 8:367–372CrossRefPubMed
33.
Meng H, Tutino VM, Xiang J, Siddiqui A (2014) High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. Am J Neuroradiol 35:1254–1262CrossRefPubMed
34.
Meng H, Wang Z, Hoi Y, Gao L, Metaxa E, Swartz DD, Kolega J (2007) Complex hemodynamics at the apex of an arterial bifurcation induces vascular remodeling resembling cerebral aneurysm initiation. Stroke 38:1924–1931CrossRefPubMedPubMedCentral
35.
Miura Y, Ishida F, Umeda Y, Tanemura H, Suzuki H, Matsushima S, Shimosaka S, Taki W (2013) Low wall shear stress is independently associated with the rupture status of middle cerebral artery aneurysms. Stroke 44:519–521CrossRefPubMed
36.
Mut F, Lohner R, Chien AC, Tateshima S, Vinuela F, Putman C, Cebral JR (2011) Computational hemodynamics framework for the analysis of cerebral aneurysms. Int J Numer Method Biomed Eng 27:822–839CrossRefPubMedPubMedCentral
37.
Nixon AM, Gunel M, Sumpio BE (2010) The critical role of hemodynamics in the development of cerebral vascular disease. J Neurosurg 112:1240–1253CrossRefPubMed
38.
Omodaka S, Inoue T, Funamoto K, Sugiyama S, Shimizu H, Hayase T, Takahashi A, Tominaga T (2012) Influence of surface model extraction parameter on computational fluid dynamics modeling of cerebral aneurysms. J Biomech 45:2355–2361CrossRefPubMed
39.
Omodaka S, Sugiyama S, Inoue T, Funamoto K, Fujimura M, Shimizu H, Hayase T, Takahashi A, Tominaga T (2012) Local hemodynamics at the rupture point of cerebral aneurysms determined by computational fluid dynamics analysis. Cerebrovasc Dis 34:121–129CrossRefPubMed
40.
Qian Y, Takao H, Umezu M, Murayama Y (2011) Risk analysis of unruptured aneurysms using computational fluid dynamics technology: preliminary results. AJNR Am J Neuroradiol 32:1948–1955CrossRefPubMed
41.
Raghavan ML, Ma B, Harbaugh RE (2005) Quantified aneurysm shape and rupture risk. J Neurosurg 102:355–362CrossRefPubMed
42.
Shojima M, Nemoto S, Morita A, Oshima M, Watanabe E, Saito N (2010) Role of shear stress in the blister formation of cerebral aneurysms. Neurosurgery 67:1268–1274CrossRefPubMed
43.
Shojima M, Oshima M, Takagi K, Hayakawa M, Katada K, Morita A, Kirino T (2006) Numerical simulation of the intra-aneurysmal flow dynamics. Interv Neuroradiol 12:49–52CrossRefPubMedPubMedCentral
44.
Shojima M, Oshima M, Takagi K, Torii R, Hayakawa M, Katada K, Morita A, Kirino T (2004) Magnitude and role of wall shear stress on cerebral aneurysm: computational fluid dynamic study of 20 middle cerebral artery aneurysms. Stroke 35:2500–2505CrossRefPubMed
45.
Shojima M, Oshima M, Takagi K, Torii R, Nagata K, Shirouzu I, Morita A, Kirino T (2005) Role of the bloodstream impacting force and the local pressure elevation in the rupture of cerebral aneurysms. Stroke 36:1933–1938CrossRefPubMed
46.
Sugiyama S, Niizuma K, Nakayama T, Shimizu H, Endo H, Inoue T, Fujimura M, Ohta M, Takahashi A, Tominaga T (2013) Relative residence time prolongation in intracranial aneurysms: a possible association with atherosclerosis. Neurosurgery 73:767–776CrossRefPubMed
47.
Sun Q, Groth A, Aach T (2012) Comprehensive validation of computational fluid dynamics simulations of in-vivo blood flow in patient-specific cerebral aneurysms. Med Phys 39:742–754CrossRefPubMed
48.
Szikora I, Paal G, Ugron A, Nasztanovics F, Marosfoi M, Berentei Z, Kulcsar Z, Lee W, Bojtar I, Nyary I (2008) Impact of aneurysmal geometry on intraaneurysmal flow: a computerized flow simulation study. Neuroradiology 50:411–421CrossRefPubMed
49.
Takao H, Murayama Y, Otsuka S, Qian Y, Mohamed A, Masuda S, Yamamoto M, Abe T (2012) Hemodynamic differences between unruptured and ruptured intracranial aneurysms during observation. Stroke 43:1436–1439CrossRefPubMed
50.
Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F (1999) Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45:119PubMed
51.
Valen-Sendstad K, Mardal KA, Mortensen M, Reif BA, Langtangen HP (2011) Direct numerical simulation of transitional flow in a patient-specific intracranial aneurysm. J Biomech 44:2826–2832CrossRefPubMed
52.
Valen-Sendstad K, Mardal KA, Steinman DA (2013) High-resolution CFD detects high-frequency velocity fluctuations in bifurcation, but not sidewall, aneurysms. J Biomech 46:402–407CrossRefPubMed
53.
Wang SZ, Chen JL, Ding GH, Lu G, Zhang XL (2010) Non-newtonian computational hemodynamics in two patient-specific cerebral aneurysms with daughter saccules. J Hydrodyn 22:639–646CrossRef
54.
Wiebers DO (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110CrossRefPubMed
55.
Xiang J, Natarajan SK, Tremmel M, Ma D, Mocco J, Hopkins LN, Siddiqui AH, Levy EI, Meng H (2011) Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke 42:144–152CrossRefPubMed
Metadaten
Titel
Hemodynamic changes in a middle cerebral artery aneurysm at follow-up times before and after its rupture: a case report and a review of the literature
verfasst von
A. Sejkorová
K. D. Dennis
H. Švihlová
O. Petr
G. Lanzino
A. Hejčl
D. Dragomir-Daescu
Publikationsdatum
24.11.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Neurosurgical Review / Ausgabe 2/2017
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-016-0795-7

Weitere Artikel der Ausgabe 2/2017

Neurosurgical Review 2/2017 Zur Ausgabe

Original Article

Cervical reconstruction techniques. After adequate selection of the patient report of a series of 34 patients treated with winged expandable cages

Review

Seizure outcomes in nonresective epilepsy surgery: an update

Original Article

Outcome of microvascular decompression for hemifacial spasm associated with the vertebral artery

Original Article

Detailed anatomy knowledge: first step to approach petroclival meningiomas through the petrous apex. Anatomy lab experience and surgical series

Review

The role of brachytherapy in the treatment of glioblastoma multiforme

Technical Note

Retrograde suction decompression of a large internal carotid aneurysm using a balloon guide catheter combined with a blood-returning circuit and STA-MCA bypass: a technical note

Neu im Fachgebiet Chirurgie

23.04.2024 | Ablationstherapie | Nachrichten

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich
weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.