Mirror aneurysms among multiple aneurysms: Lesser of the two evils

• Published in: World neurosurgery Vol. 92; pp. 126 - 132
• Main Authors: Mehrotra, Anant, PDF, Sharma, Pradeep, MS, Das, Kuntal Kanti, PDF, Bhaisora, Kamlesh Singh, MCh, Sardhara, Jayesh, MCh, Gupta, Shruti, MS, Pandey, Satyadeo, MS, Jaiswal, Awadhesh Kumar, MCh, Sahu, Rabi Narayan, MCh, Srivastava, Arun Kumar, MCh, Behari, Sanjay, MCh
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Adult; Age Factors; Angiography, Digital Subtraction; Arteriovenous Malformations - complications; Arteriovenous Malformations - diagnostic imaging; Arteriovenous Malformations - epidemiology; Arteriovenous Malformations - surgery; Cohort Studies; Computed Tomography Angiography; Craniotomy - methods; Female; Glasgow Outcome Scale; Humans; India; Infarct; Intracranial Aneurysm - complications; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - epidemiology; Intracranial Aneurysm - surgery; Male; Middle Aged; Mirror aneurysms; Moyamoya Disease - complications; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - epidemiology; Neurosurgery; Outcome; Vasospasm; vasospasm; Infarct; Mirror aneurysms; Outcome; DACA; MIA; ICA; GOS; MCA; Acomm artery; MirAn; CTA; DSA; nMirAn; Pcomm artery; Vasospasm; SAH
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.04.124

Abstract Background To highlight the management nuances in addressing mirror aneurysms in subset of multiple aneurysms Methods A retrospective study was carried out and all multiple intracranial aneurysms (n=70) over last 9 years were identified. Exclusion criteria were associated arteriovenous malformations, Moya-moya disease, either traumatic or mycotic aneurysms or those managed by endovascular approach alone. Patients were grouped as mirror and non mirror aneurysms. Outcome was assessed by Glasgow outcome score (GOS) at one month. Pearson Chi square test or Fisher exact test were used to establish association. Results Mirror aneurysms (n=17) accounted for 2.1% of all intracranial aneurysms and 24.3% of multiple aneurysms. Female predilection was eminent in the mirror aneurysm group (3.25:1) as compared to non mirror aneurysm (2.5:1). MCA (n=6) followed by ICA-pcomm (n=5) were the most common sites of the mirror aneurysms. There was no significant difference between the two groups for hypertension or age [MirAn-52yrs(±11.231); HTN-52.9%] [nMirAn-48.58yrs(±12.97); HTN-54.7%]. There was a definite trend towards less intra-operative rupture (mirror aneurysm: 4/17;Non-mirror: 27/53; p=0.048), decreased intra-operative vasospasm (mirror:1; non-mirror:11) in the mirror group. Development of infarct was significantly less in mirror aneurysm group (p=0.027) with a better outcome (13 in MirAn and 26 in nMirAn had good outcome; p=0.048). Conclusion Mirror aneurysms are not significantly associated with risk factors like age, hypertension and diabetes. Intra-operative rupture, vasospasm and infarct are less common with a tendency towards better neurological outcome as compared to non mirror aneurysms