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For treatment of unruptured cerebral aneurysm, it is important to identify whether the examined aneurysm has a high risk for future rupture. In this report we analyze the relationship of the shape of aneurysm with the appearance of aneurysmal wall, and consider the risk for rupture. There were 112 patients with 127 unruptured aneurysms in the past 7 years. We investigated the shape of aneurysm with intra-arterial digital subtraction angiography (IA-DSA) and/or 3 dimentional computed tomographic angiography (3D-CTA). The appearance of the aneurysm in the intraoperative view was also investigated. Thirty-five percent of 127 aneurysms showed an irregular shape. And 66% had a thin-red wall. Irregularly shaped aneurysms were seen in the middle of the cerebral artery (MCA), and there was a high incidence of medium-sized (4-10 mm) aneurysms. A thin-red aneurysmal wall was frequently seen in MCA aneurysms and small-sized (less than 4 mm) ones. Seventy-three percent of the irregularly shaped aneurysms showed a thin-red wall. Relatively, fewer irregularly shaped aneurysms (14%) and thin-walled aneurysms (41%) were found in the juxta-dural ring aneurysms than average. As operative outcome, mortality was 0, and morbidity was 3.6%, both less than those of ruptured aneurysms. There were 14 unruptured aneurysms without surgical treatment, and 5 of them ruptured in follow-up period. The irregularly shaped aneurysms had a high incidence of thin-red walls and seem to cause future rupture. Preventive surgical treatment is strongly recommended for these aneurysms.

Necessity of Surgical Treatment for Unruptured Cerebral Aneurysm: Based on the Shape of Aneurysm and the Appearance of Aneurysmal Wall.