Korean J Radiol.  2018 Oct;19(5):849-858. 10.3348/kjr.2018.19.5.849.

Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

Affiliations
  • 1Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea.
  • 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea. aronnn@naver.com
  • 3Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Korea.
  • 4Department of Neurosurgery, Kwangju Christian Hospital, Gwangju 61661, Korea.
  • 5Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University of Korea College of Medicine, Incheon 22711, Korea.
  • 6Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.

Abstract


OBJECTIVE
Mirror aneurysms are generally considered as a subset of multiple aneurysms, defined as aneurysms occurring bilaterally and symmetrically on the same-named vessels. Although not infrequent, the characteristics of mirror aneurysms are not well studied. This investigation was conducted to elucidate the anatomic features of such lesions and examine treatment options.
MATERIALS AND METHODS
A retrospective review was conducted, aimed at 172 patients treated for 344 mirror aneurysms between January 2007 and December 2015. Aneurysms of similar nature but in asymmetric locations on the same-named vessels were excluded. All available records were examined and lesion characteristics, as well as treatment outcomes were assessed.
RESULTS
In study subjects (n = 172), mirror aneurysms most often involved middle cerebral artery bifurcation (n = 83), followed by a paraclinoid internal carotid artery (n = 50) and posterior communicating artery (n = 21). Most of the lesions (95.3%) measured ≤ 10 mm, and in 126 patients (74.6%), the size ratios were > 50%. Of the 344 aneurysms studied, coil embolization was undertaken in 217, surgical clipping in 62, and observation alone (no treatment) in 65. Coil embolization and surgical clipping were done bilaterally in 83 and 12 patients, respectively. In 12 patients, combined coiling and clipping were implemented on each side. Single-stage coil embolization of both the aneurysms was performed in 73 patients, with excellent post-procedural (85.6%) and follow-up (86.8%) occlusive results. There was no procedure-related morbidity or mortality.
CONCLUSION
By adopting different treatment strategies to different configurations and vascular sources, mirror aneurysms can be safely and effectively treated. If feasible, single-stage coil embolization should be considered as a reasonable treatment option for mirror aneurysms.

Keyword

Aneurysm; Mirror; Treatment; Follow-up

MeSH Terms

Aneurysm*
Arteries
Carotid Artery, Internal
Embolization, Therapeutic
Follow-Up Studies
Humans
Middle Cerebral Artery
Mortality
Retrospective Studies
Surgical Instruments

Figure

  • Fig. 1 Algorithm of patient population selected for study.

  • Fig. 2 Growth of untreated mirror aneurysms. Unruptured mirror aneurysms (arrows) on MCAB: three dimensional images of right (A) and left MCAB (B); coil embolization of right MCAB aneurysm (C); and observation of left MCAB aneurysms; subarachnoid hemorrhage at 11 months after coil embolization (D); significant growth (arrow) of left MCAB aneurysm (E); and completion of angiography after coil embolization (F). MCAB = middle cerebral artery bifurcation

  • Fig. 3 De novo aneurysm at paired sites during follow-up after treatment of unilateral aneurysm. Left PcomA aneurysm (arrow) on digital subtraction angiography at baseline (A); coil embolization of left PcomA aneurysm (B); de novo right PcomA aneurysm (arrow) seen at 36 months follow-up (C); and plain radiography after coil embolization (D). ICAG = internal carotid angiography, PcomA = posterior communicating artery


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