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Venous Hypertension and Intracranial Aneurysm Rupture. Fong Y Tsai,* Andrew Yen*, Wan-You Guo**Chin C Wu** *UC Irvine Medical Center, Orange,Ca ** Taipei Veterans General Hospital,Taipei,Taiwan. Risks of Rupture Cerebral Aneurysm. 1) Size and site:
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Venous Hypertension and Intracranial Aneurysm Rupture Fong Y Tsai,* Andrew Yen*, Wan-You Guo**Chin C Wu** *UC Irvine Medical Center, Orange,Ca ** Taipei Veterans General Hospital,Taipei,Taiwan
Risks of Rupture Cerebral Aneurysm 1) Size and site: No difference in size, posterior fossa and posterior communicating and PCA more likely rupture, 2) Configuration: lobulation 3) Smoking, hypertension 4) Wall shear stress and tension 5) Hemodynamic patterns 6) Flow patterns: hemodynamic profile
Risks of ruptured Cerebral Aneurysm • Hemodynamic profiles: • 1)Flow patterns: Intraneurysmal flow • 2)Jet wave: ruptured aneurysm with small jet size • 3)Impingment region:Dome,body,neck, ruptured with small impingement zone • 4)Geometry of aneurysm
Asymmetry Dural Sinus Potential factor: venous hypertension from asymmetrical dural sinus
Materials:Retrospective • 193 patients: 131 females and 62 males • Age ranged from 15 to 90 in female and 26 to 81 in males • 140 had ruptured aneurysm • 87 of 140 had venous asymmetry • Females: 60 of 91 ruptured aneurysm had venous asymmetry • Males: 27 of 49 ruptured aneurysm had venous asymmetry
Case Presentation Case 1 57/F presented with worse headache of life with clinical Grade 2 SAH
Case Presentation Case 2 53/M presented with recurrent headache, negative neural examinations
Case Presentation Case 3 37/M recurrent headache
Case Presentation Case 4 66/F presented with severe headache and grade 2 clinically
Venous Pressure Measurement By MRI • Phase Contrast • Standard fluid dynamics • Poiseuille’s Law:
Right central Q1(L) Q1(R) Q2(L) Q2(R) Q1(R) Right lateral Q2(R) Left central Q1(L) Left lateral Q2(L)
Calculation Of Pressure ΔPr/Pl=75.26%
Pressure Gradient Left venous pressure is 24.76% higher than right side
Conclusion • Preliminary data demonstrated association of rupture cerebral aneurysm with venous sinus asymmetry • Preliminary MR phase contrast venous pressure measurement showed pressure gradient in asymmetry of dural sinuses