Int J Angiol 2024; 33(01): 022-028
DOI: 10.1055/s-0043-1774740
Original Article

Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms

1   Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Perú
2   Department of Neurological Surgery, University of Washington, Seattle, Washington
Rosa Cervantes-Medina
3   Department of Radiology, Interventional Radiology Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Perú
Rodolfo Rodríguez-Varela
1   Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Perú
› Author Affiliations
Funding None.


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.

Publication History

Article published online:
14 September 2023

© 2023. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Żurada A, Gielecki J, Tubbs RS. et al. Three-dimensional morphometrical analysis of the M1 segment of the middle cerebral artery: potential clinical and neurosurgical implications. Clin Anat 2011; 24 (01) 34-46
  • 2 Tarasów E, Abdulwahed Saleh Ali A, Lewszuk A, Walecki J. Measurements of the middle cerebral artery in digital subtraction angiography and MR angiography. Med Sci Monit 2007; 13 (1, Suppl 1): 65-72
  • 3 Vuillier F, Medeiros E, Moulin T, Cattin F, Bonneville J-F, Tatu L. Main anatomical features of the M1 segment of the middle cerebral artery: a 3D time-of-flight magnetic resonance angiography at 3 T study. Surg Radiol Anat 2008; 30 (06) 509-514
  • 4 Tanriover N, Kawashima M, Rhoton Jr AL, Ulm AJ, Mericle RA. Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg 2003; 98 (06) 1277-1290
  • 5 Umansky F, Juarez SM, Dujovny M. et al. Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 1984; 61 (03) 458-467
  • 6 Han J, Qiao H, Li X. et al. The three-dimensional shape analysis of the M1 segment of the middle cerebral artery using MRA at 3T. Neuroradiology 2014; 56 (11) 995-1005
  • 7 Elsharkawy A, Lehečka M, Niemelä M. et al. A new, more accurate classification of middle cerebral artery aneurysms: computed tomography angiographic study of 1,009 consecutive cases with 1,309 middle cerebral artery aneurysms. Neurosurgery 2013; 73 (01) 94-102 , discussion 102
  • 8 Rai AT, Hogg JP, Cline B, Hobbs G. Cerebrovascular geometry in the anterior circulation: an analysis of diameter, length and the vessel taper. J Neurointerv Surg 2013; 5 (04) 371-375
  • 9 Sadatomo T, Yuki K, Migita K, Imada Y, Kuwabara M, Kurisu K. Differences between middle cerebral artery bifurcations with normal anatomy and those with aneurysms. Neurosurg Rev 2013; 36 (03) 437-445
  • 10 Sugahara T, Korogi Y, Nakashima K, Hamatake S, Honda S, Takahashi M. Comparison of 2D and 3D digital subtraction angiography in evaluation of intracranial aneurysms. AJNR Am J Neuroradiol 2002; 23 (09) 1545-1552
  • 11 Brinjikji W, Cloft H, Lanzino G, Kallmes DF. Comparison of 2D digital subtraction angiography and 3D rotational angiography in the evaluation of dome-to-neck ratio. AJNR Am J Neuroradiol 2009; 30 (04) 831-834
  • 12 Pedicelli A, Rollo M, Di Lella GM, Tartaglione T, Colosimo C, Bonomo L. 3D rotational angiography for the diagnosis and preoperative assessment of intracranial aneurysms: preliminary experience. Radiol Med (Torino) 2007; 112 (06) 895-905
  • 13 Sadato A, Hayakawa M, Tanaka T, Hirose Y. Comparison of cerebral aneurysm volumes as determined by digitally measured 3D rotational angiography and approximation from three diameters. Interv Neuroradiol 2011; 17 (02) 154-158
  • 14 Bau Alegria J. Reconstrucción 3D angiográfica en el diagnóstico y el tratamiento de aneurismas cerebrales. Imagen Diagn 2010; 1 (02) 51-55
  • 15 Asgari S, Luo Y, Akbari A. et al. A positively selected FBN1 missense variant reduces height in Peruvian individuals. Nature 2020; 582 (7811): 234-239
  • 16 Silva Neto ÂR, Câmara RLB, Valença MM. Carotid siphon geometry and variants of the circle of Willis in the origin of carotid aneurysms. Arq Neuropsiquiatr 2012; 70 (12) 917-921
  • 17 Sakamoto S, Ohba S, Shibukawa M. et al. Characteristics of aneurysms of the internal carotid artery bifurcation. Acta Neurochir (Wien) 2006; 148 (02) 139-143 , discussion 143
  • 18 Kim D-W, Kang S-D. Association between internal carotid artery morphometry and posterior communicating artery aneurysm. Yonsei Med J 2007; 48 (04) 634-638
  • 19 Joo W, Funaki T, Yoshioka F, Rhoton Jr AL. Microsurgical anatomy of the carotid cave. Neurosurgery 2012; 70 (2, Suppl Operative): 300-311 , discussion 311–312
  • 20 Waihrich E, Clavel P, Mendes GAC, Iosif C, Moraes Kessler I, Mounayer C. Influence of carotid siphon anatomy on brain aneurysm presentation. AJNR Am J Neuroradiol 2017; 38 (09) 1771-1775
  • 21 Arat YO, Arat A, Aydin K. Angiographic morphometry of internal carotid artery circulation in Turkish children. Turk Neurosurg 2015; 25 (04) 608-616
  • 22 Labeyrie P-E, Gory B, Huguet N. et al. Carotid siphon morphology: is it associated with posterior communicating aneurysms?. Interv Neuroradiol 2016; 22 (04) 378-382
  • 23 Kim BJ, Yoon Y, Lee D-H, Kang D-W, Kwon SU, Kim JS. The shape of middle cerebral artery and plaque location: high-resolution MRI finding. Int J Stroke 2015; 10 (06) 856-860