1、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 wall formation might be one of their underlying causes.Early rupture in patients with no extrinsic risk factors s
2、upport 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 the primarily abnormal vessel wall.Prevalence:Constitute less than 5%of overall aneurysms Account for approximat
3、ely 20%30%among multiple 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 Location Common location
4、: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%)Gender distribution MirAN VS nMirANs with mutiple intracran
5、ial 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 between June 2007 and July 2011 Female/male ratio:2.3:1 Average age at presentation/rupture for MirANs and nMirANs
6、 patients was in the 5th decade Women presented later than men in MirANs and nMirANsOur result 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 pati
7、ents with ruptured MirANs:62.79.9 Casimiro,MV，et al .Surg Neurol,2004;61:5415Risk 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
8、 presentation in MirAns vs nMirAns:58.79.2 vs 5610.4Hypertension was the 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 with
9、out recognized risk factors.No known extrinsic risk factors was the main characteristic of the subset of MirAn patients 40 years.Casimiro,MV，et al .Surg Neurol,2004;61:5415suit for one stage operation,the duty aneurysm should beUncommon，special subgroup of mutiple intracranial aneurysms;occuring at
10、roughly the same location on each 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 s
11、ite/the most thick site of 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 2
12、0115:1 VS 1:1A congenital 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 decadeHy
13、pothesis on genesis and 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.Age pattern of disease presentation fo
14、r 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 factors.suit for on
15、e 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 nRF=No known extrinsic risk factors.Our result from 50 patients with MirANsEarly rupture in pati
16、ents 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 2011Other location(2%)Familial and twin intracranial aneurysm:6570%Pre-embolizationAge pattern of
17、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 is performed,the one stage operation or twoGender distributionsuit for one stage operation,the duty
18、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.MRA CTA DSA Identification of duty lesion on MirANsCT/MRI Hematoma site/the most thick site of SAH CTA/MRA/
19、DSA Aneurysm size Aneurysm morphology Parent artery and/or adjacent artery spasm Therapeutic decision-making on MirANs Whether intracranial unruptured MirANs should be treated?Depend on the well known factors such as age of the patient,localization and size of the aneurysm.should be discussed with t
20、he 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 featuresIf treatment is performed,the one stage operation or two stage operation was choose.The first cho
21、ice is one stage operation,but if the patient is not suit for one stage operation,the duty aneurysm should be treated firstCase 1 M,64 Y,progressive enlargement of incidently found aneurysmPre-embolization Post-embolization Pre-embolization Post-embolization Case 2 F,57 Y,SAH LRLRRLMANs account for
22、26.Age pattern of disease presentation for the general 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 f
23、rom 50 patients with MirANsHypertensionpatients 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 s
24、izethe start of the 6th decadeDepend on the location and aneurysm featuresNo known extrinsic risk factorsPre-embolization Post-embolization LLPre-embolization Post-embolization Age pattern of disease presentation for the general MirAN population and for the risk factors HBP=High blood pressure,S=Cig
25、arette smoking,and nRF=No known extrinsic risk factors.Age 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.Relative prevalence of each risk factor by age group in MirAn HB
26、P=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.Relative prevalence of each risk factor by age group in nMirAnHBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.HypertensionHypertensionDefinition of MirANRisk factorsPost-embolization
27、C6(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 rupture in patients with no extrinsic risk factors support the role of a congenital predisposit
28、ion over degenerative causes in the patients with MirAN.Hypertension type:incomplete symmetryPre-embolizationPre-embolizationlocalization and size of the aneurysm.Pre-embolizationCasimiro,MV，et al .Constitute less than 5%of overall aneurysmsEpidemiology of MirANsthe start of the 6th decadeEarly rupt
29、ure 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 patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative
30、 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 overall aneurysmsFemale/male ratio:3.Constitute less than 5%of overall aneurysmsC6(24%)type:incomplete symme
31、tryEpidemiology 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 factorsMirAN VS nMirANs with mutiple intracranial aneurysms-Risk factorsstage operation was choose.No known e
32、xtrinsic 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.Hematoma site/the most thick site of SAHPost-embolization5:1 VS 1:1Pre-embolizationFamilial and twin intracranial an
33、eurysm: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 early embryological derangement of vascular wall formation might be one of their underlying causes.Post-embolizationSurg Ne
34、urol,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-embolizationCigarette SmokingHypothesis on genesis and growth of MirANsOur result from 50 patients with MirANsSurg Neurol,
35、2004;61:5415 type:incomplete symmetryA congenital predisposition,and the early embryological derangement of vascular wall formation might be one of their underlying causes.Pre-embolization5:1 VS 1:1HypertensionWomen presented later than men in MirANs and nMirANsNo known extrinsic risk factors was th
36、e 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 congenital predisposition,and the early embryological derangement of vascular wall formation might be one of their underlying causes
37、.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 patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients wit
38、h 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 blood p
39、ressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.Female/male ratio:3.Pre-embolizationMirANs diagnosis approachesNo known extrinsic risk factorsAneurysm morphologyEarly rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerat
40、ive causes in the patients with MirAN.Age pattern of disease presentation for the general no-MirAN population and for the risk factorsConstitute less than 5%of overall aneurysms5:1 VS 1:1Epidemiology of MirANsAge pattern of disease presentation for the general MirAN population and for the risk facto
41、rsRisk factors type:incomplete symmetryPost-embolization type:complete symmetryCasimiro,MV，et al .Familial and twin intracranial aneurysm:6570%HBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.Familial and twin intracranial aneurysm:6570%Early rupture in patients wi
42、th no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Early rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Age pattern of disease presentation for the general MirAN population and for the risk factorsWomen presented later than men in MirANs and nMirANsHypertensionPre-embolizationEpidemiology of MirANs
