Detection of wall and neck calcification of unruptured intracranial aneurysms with flat-detector computed tomography

Abstract

<jats:sec><jats:title>Object</jats:title><jats:p> Microsurgical clipping is a widely used surgical technique in intracranial aneurysm treatment. It can be difficult in large sized aneurysms, and those with wide necks, thick walls and calcification located in the vicinity of the neck. This study reviewed calcification of the intracranial aneurysm wall and its relation to patient age, gender, location and size of the aneurysm. A possible cut-off value after which the aneurysm calcification rate increases was also investigated to classify patients’ risk factors for microclipping. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A retrospective review of all unruptured intracranial aneurysms that underwent digital subtraction angiography at a single centre was performed. Flat-detector computed tomography images of the aneurysm were reviewed for aneurysm location, size and calcification. The independent samples t test and χ<jats:sup>2</jats:sup> test were used to show the relation between aneurysm wall calcification and patient age, gender, aneurysm localisation and size. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> None of the reviewed factors were statistically significantly related to aneurysm calcification except aneurysm size ( P &lt; 0.01). Receiver operating characteristic curves showed aneurysms greater than 10.5 mm could be predicted to be calcified with a sensitivity of 80% and specificity of 63%. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> In this study, the presence of calcification was related to aneurysm size. Larger aneurysms were more likely to be calcified. Aneurysms greater than 10.5 mm should be further investigated with a modality such as flat-detector computed tomography to show the calcification in detail, especially if microclipping is considered. </jats:p></jats:sec>

Massively calcified aneurysm of the anterior communicating artery: an unsuccessful clipping attempt followed by successful pCONus2-assisted coil occlusion

“…Furthermore, calcification may prevent correct positioning of the clip on the neck, thus hindering proper closure with consecutive residual perfusion as in our patient. Calcification may also result in slipping of the clip and subsequently in repeated clip adjustments and the occlusion of distal branches [ 3 , 4 , 6 ]. In our patient, the aneurysm was massively calcified, rather ossified and had become inseparable from the skull which made clipping extremely dangerous.…”

Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136�cases

“…Currently, the surgical clipping of intracranial aneurysms is a popular treatment (16). Neurosurgical clipping can be affected by numerous factors, including the age and sex of the patient, the location and size of the aneurysm, and the extent of calcification or sclerosis of the aneurysm and parent artery (14). Among these factors, arteriosclerosis and calcification of the aneurysm and parent artery are particularly important.…”

Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management

“…Advances in imaging technologies have improved our comprehension of the 3D geometry of cerebral aneurysms, which has further affected treatment procedures, and helps neurosurgeons in the diagnosis, planning, and assessment of the therapeutic modalities. Exact information must be obtained preoperatively regarding the location, size, and morphology of the aneurysm and the property of the aneurysmal wall, its relationship with the parent vessel and adjacent branches, vessel incorporation, presence of calcification or thrombus[ 9 ]. Perianeurysmal information such as associated vasospasm, vascular variants, presence of vascular malformations, and the relationship of the aneurysm to the bony skull base is also crucial for proper treatment method selection.…”