• Anil Can, Allen L Ho, Ruben Dammers, Clemens M F Dirven, and Rose Du.
• *Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; ‡Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
• Neurosurgery. 2015 Jun 1;76(6):721-6; discussion 726-7.

BackgroundMorphological factors contribute to the hemodynamics of the middle cerebral artery (MCA).ObjectiveTo identify image-based morphological parameters that correlated with the presence of MCA aneurysms.MethodsImage-based anatomic parameters obtained from 110 patients with and without MCA bifurcation aneurysms were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined segment lengths, diameters, and vessel-to-vessel angles of the parent and daughter vessels at the MCA bifurcation. In order to reduce confounding by genetic and clinical risk factors, 2 control groups were selected: group A (the unaffected contralateral side of patients with unilateral MCA bifurcation aneurysms) and group B (patients without intracranial aneurysms or other vascular malformations). Univariate and multivariate analyses were performed to determine statistical significance.ResultsOne hundred ten patients who were evaluated from 2007 to 2014 were analyzed (73 patients with MCA aneurysms and 37 control patients). Multivariate analysis revealed that a smaller parent artery diameter (group A: odds ratio [OR] 0.20, P < .01, group B: OR 0.23, P < .01) and a larger daughter-to-daughter branch angle (group A: OR 1.01, P = .04, group B: OR 1.02, P = .04) were most strongly associated with MCA aneurysm presence after adjusting for other morphological factors.ConclusionSmaller parent artery diameter and larger daughter-to-daughter branch angles are associated with the presence of MCA bifurcation aneurysms. These easily measurable parameters may provide objective metrics to assess aneurysm formation and growth risk stratification in high-risk patients.

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