Gender Differences in Cerebral Aneurysm Location

Abstract

Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress. This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there exists a gender discrepancy in the anatomic distribution of cerebral aneurysms. Methods: A retrospective review of consecutive patients with ruptured and unruptured intradural saccular cerebral aneurysms treated endovascularly was performed. Results: Six hundred eighty-two aneurysms were treated. Seventy-two percentage of the patients were women and 27% of patients presented with SAH. Among women, most aneurysms were located along the ICA (54%) while men the ACA (29%, compared to 15% in women), a discrepancy evident in both unruptured and ruptured groups. Females tended to present later in life (59 vs. 55 years), with multiple aneurysms (11 vs. 6% in men), and with SAH (28 vs. 23% in men) – the majority of these ruptured aneurysms were located at the ICA (42%), while men at the ACA (47%). Additionally, the majority (68%) of ruptured ICA aneurysms were PCOM. Conclusion: Understanding the natural history of aneurysms is imperative in treating incidentally found aneurysms. Significant differences exist between the genders in relation to aneurysm location, the most pronounced at the ICA and ACA. Previously described hormonal and hemodynamic theories behind cerebral aneurysm pathogenesis seem like plausible reasons to explain these differences.

The incidence of hemorrhagic stroke in Japan is twice compared with western countries: the Akita stroke registry

“…Women showed 1.4 times higher incidence than men and the location of ruptured aneurysm showed sex difference clearly [27][28][29]. SAH occurs more often in women.…”

The Factors Associated with Outcomes in Surgically Managed Ruptured Cerebral Aneurysm

“…This is correlated to the drop in estrogen level during the post-menopausal period among the women, as suggested by Ghods et al (10). Estrogen has been shown to promote normal physiologic vascular endothelial function and reduction in the estrogen level leads to compromised arterial integrity, and hence, the development of an aneurysm (10). Female patients tend to have a poorer outcome probably due to multiple comorbid and late presentation to the hospital.…”

Multidisciplinary management of intracranial aneurysms: The experience of Lille university hospital center

“…Among clinical data, the American Society of Anesthesiologists score [19] (ASA) and the World Federation of Neurosurgical Societies score [20] (WFNS) were recorded before treatment and all patients were re-evaluated 3 months after treatment using a modified Rankin Scale [21] (mRS). All patients who underwent endovascular treatment had a conventional cerebral angiography before treatment, and at the end of the procedure.…”