Carotid siphon morphology: Is it associated with posterior communicating aneurysms?

Labeyrie, Paul‐Emile; Gory, Benjamin; Huguet, Nazyad; Grenier, Charlotte; Ditac, Geoffroy; Sadeh-Gonik, Udi; Riva, Roberto; Turjman, Francis

doi:10.1177/1591019916637344

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…20 In addition, whether the geometry of the carotid siphon could led to aneurysm development is unclear. 16,18,22 Our results yielded shorter and narrower mean diameters and lengths of the entire MCA compared with previous reports. We also found shorter diameters in the MCA in the aneurysm group at the three studied segments.…”

Section: Discussionsupporting

confidence: 45%

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Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms

Saal-Zapata,

Walker,

Cervantes-Medina

et al. 2023

Int J Angiol

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This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian academic medical center between December 2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms and matched controls who underwent 3DRA. Angiographic images were obtained per standard of care, and measurements of the vasculature were performed using 3DRA vascular automated software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2). In multivariate analysis, five specific features were found to be statistically significant predictors for presence of an anterior circulation aneurysm: female sex (odds ratio [OR] = 2.71; p = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; p = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; p = 0.012), ICA bifurcation angle (OR = 1.02; p = 0.036), and length of the carotid siphon (OR = 1.08; p = 0.047). Features detected on 3DRA suggest morphological characteristics of the ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior reports by demonstrating five specific patient and imaging features associated with anterior circulation aneurysms. While 3DRA is the standard of care in many settings, medical centers with resource limitations may not have access to this technique. The demographic and morphological features identified in our study may have correlates that if detected on contrast computed tomography or magnetic resonance imaging studies, may be used to help screen for a higher level of care in select patients.

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Section: Discussionsupporting

confidence: 45%

“…20 In addition, whether the geometry of the carotid siphon could led to aneurysm development is unclear. 16 18 22…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms

Saal-Zapata,

Walker,

Cervantes-Medina

et al. 2023

Int J Angiol

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“…Lauric et al. showed that the high bend curvature of the carotid siphon could induce destructive vessel wall remodeling and siphon aneurysm initiation [ 9 ]; however, one study found no association between the morphological characteristics of the carotid siphon and the occurrence of PCoA aneurysm [ 10 ]. Patients with S‑shaped siphons, which are more torturous than V‑shaped siphons, were found to be less prone to developing IAs [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The tortuosity of the ICA is hypothesized to be associated with IA formation. Unexpectedly, another study revealed no link between the morphological characteristics of carotid siphons and the incidence of PCoA aneurysm [ 10 ]. Double bend (S-shaped) siphons are more tortuous than V‑shaped siphons.…”

Section: Introductionmentioning

confidence: 99%

Effect of Siphon Morphology on the Risk of C7 Segment Aneurysm Formation

Wang,

Chen,

Song

et al. 2024

Clin Neuroradiol

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Purpose Tortuosity of the internal carotid artery (ICA) is associated with intracranial aneurysms (IAs). The siphon is the most curved segment of the ICA, but its morphology has controversial effects on IAs. This study aimed to explore the morphometric features of the siphon and the potential hemodynamic mechanisms that may affect C7 aneurysm formation. Methods In this study 32 patients with C7 aneurysms diagnosed at Xiangya Hospital between 2019 and 2021 and 32 control subjects were enrolled after propensity score matching. Computed tomography angiography (CTA) images were acquired to measure morphologic features, and then, by combining clinical data, simplified carotid siphon models were constructed, and computational fluid dynamics (CFD) analysis was performed. Results The presence of C7 aneurysms was associated with the height of the C4–C6 curved arteries (odds ratio [OR] 0.028, 95% confidence interval [CI] 0.003–0.201; P < 0.001). The heights of the C4–C6 curved arteries in the aneurysm group were significantly shorter than those in the control group. The CFD analysis revealed that shorter C4–C6 bends led to greater blood velocity and pressure in the C7 segment arteries. Conclusion A shorter C4–C6 bend was associated with distal C7 aneurysm formation, and an elaborate hemodynamic mechanism may underlie this association.

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“…The morphologic variations of the supraclinoid carotid siphon of the ICA are very important. ICA-PcomA aneurysm of the low-lying and short ICA carries potential risks, such as no clipping space for proximal control and hidden aneurysm complex under the tent 25, 26, 27, 28. As many as 11.1%–15.5% of ICA-PcomA aneurysms require either anterior clinoidectomy or resection of the tent for clipping via standard craniotomy 25, 29.…”

Section: Discussionmentioning

confidence: 99%

Potential Risks and Limited Indications of the Supraorbital Keyhole Approach for Clipping Internal Carotid Artery Aneurysms

Toyo’oka

Wada

Otani

et al. 2019

World Neurosurgery: X

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Background Internal carotid artery (ICA) aneurysm may be a good target for supraorbital keyhole clipping. We discuss the surgical indications and risks of keyhole clipping for ICA aneurysms based on long-term clinical and radiologic results. Methods This was a retrospective analysis of 51 patients (aged 35–75 years, mean 62 years) with ICA aneurysms (mean 5.8 ± 1.8 mm) who underwent clipping via the supraorbital keyhole approach between 2005 and 2017. Neurologic and cognitive functions were examined by several methods, including the modified Rankin Scale and Mini-Mental Status Examination. The state of clipping was assessed 1 year and then every few years after the operation. Results Complete clipping was confirmed in 45 patients (88.2%), dog-ear remnants behind the clip persisted in 4 patients, and wrapping was performed in 2 patients. Mean duration of postoperative hospitalization was 3.4 ± 6.9 days. The mean clinical follow-up period was 6.6 ± 3.2 years. The overall mortality was 0, and overall morbidity (modified Rankin Scale score ≥2 or Mini-Mental Status Examination <24) was 3.9%. Completely clipped aneurysms did not show any recurrence during the mean follow-up period of 6.3 ± 3.1 years, but the 2 (3.9%) aneurysms with neck remnants showed regrowth. Conclusions The risk of neck remnant behind the clip blade is a drawback of supraorbital keyhole clipping. The surgical indication requires preoperative simulation and careful checking of the clip blade state is essential.

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Carotid siphon morphology: Is it associated with posterior communicating aneurysms?

Cited by 4 publications

References 23 publications

Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms

Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms

Effect of Siphon Morphology on the Risk of C7 Segment Aneurysm Formation

Potential Risks and Limited Indications of the Supraorbital Keyhole Approach for Clipping Internal Carotid Artery Aneurysms

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