Background and Purpose: A community-based study was conducted to estimate the site distribution of ruptured intracranial aneurysms and to evaluate clinical features related to aneurysm site. Methods: The author reviewed data from 358 patients with aneurysmal subarachnoid hemorrhage (SAH) treated between 1980 and 1998 in Izumo, Japan. In 291 of these patients, the sites of the ruptured aneurysms were confirmed. Results: The aneurysm arose from the anterior communicating artery (AcoA) in 101 patients, the distal anterior cerebral artery (ACA) in 24, the internal carotid artery (ICA) in 70, the middle cerebral artery (MCA) in 77, and the vertebrobasilar artery (VBA) in 19. Regardless of age, ACoA aneurysms were more frequent in men, whereas ICA aneurysms were more common in women. Intracerebral hemorrhage was more frequent in patients with MCA aneurysms, whereas intraventricular hemorrhage was more common in those with VBA, ACoA and distal ACA aneurysms. While the incidence of symptomatic vasospasm was not related to aneurysm site, the patients who died due to vasospasm harbored an ACoA or ICA aneurysm. The incidence of hydrocephalus was relatively high in patients with ACoA, ICA and VBA aneurysms, and low in those with MCA aneurysms. The overall outcome was best in patients with MCA aneurysms, followed by those with aneurysms of the ACA, including ACoA and distal ACA, ICA and VBA; these results were in good agreement with the admission grades. Conclusions: The roughly estimated proportions of the sites of aneurysm rupture were 40% for the ACA, including ACoA and distal ACA, 25% for the ICA, 25% for the MCA, and 10% for the VBA. The clinical features showed significant differences according to aneurysm site.

1.
Inagawa T, Ishikawa S, Aoki H, Takahashi M, Yoshimoto H: Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane Prefecture of Japan. Incidence. Stroke 1988;19:170–175.
2.
Menghini VV, Brown RD Jr, Sicks JD, O’Fallon WM, Wiebers DO: Clinical manifestations and survival rates among patients with saccular intracranial aneurysms: population-based study in Olmsted County, Minnesota, 1965 to 1995. Neurosurgery 2001;49:251–258.
3.
Nagura J, Suzuki K, Hayashi M, Sakamoto T, Shindo K, Oishi H, Hayashi K, Ozasa K, Watanabe Y: Stroke subtypes and lesion sites in Akita, Japan. J Stroke Cerebrovasc Dis 2005;14:1–7.
4.
Schievink WI, Wijdicks EF, Piepgras DG, Chu CP, O’Fallon WM, Whisnant JP: The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. J Neurosurg 1995;82:791–795.
5.
Berry RG, Alpers BJ, White JC: The site, structure and frequency of intracranial aneurysms, angiomas and arteriovenous abnormalities. Res Publ Assoc Res Nerv Ment Dis 1966;41:40–72.
6.
Bowen DA: Ruptured berry aneurysms: a clinical, pathological and forensic review. Forensic Sci Int 1984;26:227–234.
7.
Char G, Persaud V: Berry aneurysms of the circle of Willis: results of an autopsy study at the University Hospital of the West Indies. West Indian Med J 1984;33:151–157.
8.
Chason JL, Hindman WM: Berry aneurysms of the circle of Willis; results of a planned autopsy study. Neurology 1958;8:41–44.
9.
Dinning TAR, Falconer MA: Sudden or unexpected natural death due to ruptured intracranial aneurysm; survey of 250 forensic cases. Lancet 1953;265:799–801.
10.
Freytag E: Fatal rupture of intracranial aneurysms: survey of 250 medicolegal cases. Arch Pathol 1966;81:418–424.
11.
Housepian EM, Pool JL: A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956. J Neuropathol Exp Neurol 1958;17:409–423.
12.
Inagawa T, Hirano A: Ruptured intracranial aneurysms: an autopsy study of 133 patients. Surg Neurol 1990;33:117–123.
13.
Iwamoto H, Kiyohara Y, Fujishima M, Kato I, Nakayama K, Sueishi K, Tsuneyoshi M: Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30 year observation period: the Hisayama study. Stroke 1999;30:1390–1395.
14.
McCaughey WTE: Ruptured intracranial aneurysms. Ulster Med J 1956;25:111–118.
15.
McCormick WF: Intracranial arterial aneurysm: a pathologist’s View. Curr Concepts Cererbrovasc Dis Stroke 1973;8:15–19.
16.
McCormick WF, Nofzinger JD: Saccular intracranial aneurysms: an autopsy study. J Neurosurg 1965;22:155–159.
17.
Stehbens WE: Aneurysms and anatomical variation of cerebral arteries. Arch Pathol 1963;75:45–64.
18.
Wilson G, Riggs HE, Rupp C: The pathologic anatomy of ruptured cerebral aneurysms. J Neurosurg 1954;11:128–134.
19.
Inagawa T: Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 1990;106:119–126.
20.
Inagawa T: Cerebral vasospasm in elderly patients treated by early operation for ruptured intracranial aneurysms. Acta Neurochir (Wien) 1992;115:79–85.
21.
Inagawa T: Management outcome in the elderly patient following subarachnoid hemorrhage. J Neurosurg 1993;78:554–561.
22.
Inagawa T, Kamiya K, Matsuda Y: Effect of continuous cisternal drainage on cerebral vasospasm. Acta Neurochir (Wien) 1991;112:28–36.
23.
Inagawa T, Kamiya K, Ogasawara H, Yano T: Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 1987;28:93–99.
24.
Inagawa T, Yamamoto M, Kamiya K, Ogasawara H: Management of elderly patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 1988;69:332–339.
25.
Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 1990;73:18–36.
26.
Rosenørn J, Eskesen V, Schmidt K: Clinical features and outcome in females and males with ruptured intracranial saccular aneurysms. Br J Neurosurg 1993;7:287–290.
27.
Røsenorn J, Eskesen V, Schmidt K, Espersen JO, Haase J, Harmsen A, Hein O, Knudsen V, Midholm S, Marcussen E, Rasmussen P, Rønde F, Voldby B, Hansen L: Clinical features and outcome in 1,076 patients with ruptured intracranial saccular aneurysms: a prospective consecutive study. Br J Neurosurg 1987;1:33–45.
28.
Kassell NF, Drake CG: Timing of aneurysm surgery. Neurosurgery 1982;10:514–519.
29.
Kongable GL, Lanzino G, Germanson TP, Truskowski LL, Alves WM, Torner JC, Kassell NF: Gender-related differences in aneurysmal subarachnoid hemorrhage. J Neurosurg 1996;84:43–48.
30.
Locksley HB: Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6,368 cases in the cooperative study. J Neurosurg 1966;25:321–368.
31.
Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, Jane JA, Participants T: Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg 1996;85:410–418.
32.
Sakaki S, Ohta S, Ohue S, Kohno K, Matsuoka K: Outcome in elderly patients with ruptured intracranial aneurysm. Clin Neurol Neurosurg 1989;91:21–27.
33.
Pasqualin A, Bazzan A, Cavazzani P, Scienza R, Licata C, Da Pian R: Intracranial hematomas following aneurysmal rupture: experience with 309 cases. Surg Neurol 1986;25:6–17.
34.
Tokuda Y, Inagawa T, Katoh Y, Kumano K, Ohbayashi N, Yoshioka H: Intracerebral hematoma in patients with ruptured cerebral aneurysms. Surg Neurol 1995;43:272–277.
35.
Inagawa T: Effect of early operation on cerebral vasospasm. Surg Neurol 1990;33:239–246.
36.
Säveland H, Ljunggren B, Brandt L, Messeter K: Delayed ischemic deterioration in patients with early aneurysm operation and intravenous nimodipine. Neurosurgery 1986;18:146–150.
37.
Dorai Z, Hynan LS, Kopitnik TA, Samson D: Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003;52:763–771.
38.
Gruber A, Reinprecht A, Bavinzski G, Czech T, Richling B: Chronic shunt-dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms. Neurosurgery 1999;44:503–512.
39.
Pietilä TA, Heimberger KC, Palleske H, Brock M: Influence of aneurysm location on the development of chronic hydrocephalus following SAH. Acta Neurochir (Wien) 1995;137:70–73.
40.
Tapaninaho A, Hernesniemi J, Vapalahti M, Niskanen M, Kari A, Luukkonen M, Puranen M: Shunt-dependent hydrocephalus after subarachnoid haemorrhage and aneurysm surgery: timing of surgery is not a risk factor. Acta Neurochir (Wien) 1993;123:118–124.
41.
Vale FL, Bradley EL, Fisher WS III: The relationship of subarachnoid hemorrhage and the need for postoperative shunting. J Neurosurg 1997;86:462–466.
42.
Yoshioka H, Inagawa T, Tokuda Y, Inokuchi F: Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage. Surg Neurol 2000;53:119–125.
43.
Disney L, Weir B, Grace M: Factors influencing the outcome of aneurysm rupture in poor grade patients: a prospective series. Neurosurgery 1988;23:1–9.
44.
Huang J, van Gelder JM: The probability of sudden death from rupture of intracranial aneurysms: a meta-analysis. Neurosurgery 2002;51:1101–1107.
45.
Säveland H, Brandt L: Which are the major determinants for outcome in aneurysmal subarachnoid hemorrhage? A prospective total management study from a strictly unselected series. Acta Neurol Scand 1994;90:245–250.
46.
Inagawa T: What are the actual incidence and mortality rates of subarachnoid hemorrhage? Surg Neurol 1997;47:47–53.
47.
Inagawa T: Trends in incidence and case fatality rates of aneurysmal subarachnoid hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998. Stroke 2001;32:1499–1507.
48.
Inagawa T: What are the actual incidence and mortality rates of intracerebral hemorrhage? Neurosurg Rev 2002;25:237–246.
49.
Inagawa T: Risk factors for aneurysmal subarachnoid hemorrhage in patients in Izumo City, Japan. J Neurosurg 2005;102:60–67.
50.
Inagawa T: Trends in surgical and management outcomes in patients with aneurysmal subarachnoid hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998. Cerebrovasc Dis 2005;19:39–48.
51.
Inagawa T: Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan. Acta Neurochir (Wien) 2009;151:1623–1630.
52.
Inagawa T: Size of ruptured intracranial saccular aneurysms in patients in Izumo City, Japan. World Neurosurgery 2010; in press.
53.
Teasdale G, Jennett B: Assessment of coma and impaired consciousness: a practical scale. Lancet 1974;ii:81–84.
54.
Drake CG: Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Haemorrhage Grading Scale (letter). J Neurosurg 1988;68:985–986.
55.
Inagawa T: Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane, Japan. World Neurosurgery 2010; in press.
56.
Inagawa T, Yamamoto M, Kamiya K: Effect of clot removal on cerebral vasospasm. J Neurosurg 1990;72:224–230.
57.
Fisher CM, Kistler JP, Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980;6:1–9.
58.
Jennett B, Bond M: Assessment of outcome after severe brain damage: a practical scale. Lancet 1975;i:480–484.
59.
Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.
60.
Cox DR: Regression models and life-tables. J R Stat Soc (B) 1972;34:187–202.
61.
Inagawa T, Ohbayashi N, Hada H: Rapid spontaneous diminution of cisternal blood on computed tomography in patients with subarahnoid hemorrhage. Surg Neurol 1995;44:356–364.
62.
Inagawa T, Ohbayashi N, Kumano K: Effect of rapid spontaneous diminution of subarachnoid hemorrhage on cerebral vasospasm. Surg Neurol 1995;43:25–30.
63.
de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ: Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007;78:1365–1372.
64.
Koffijberg H, Buskens E, Granath F, Adami J, Ekbom A, Rinkel GJ, Blomqvist P: Subarachnoid haemorrhage in Sweden 1987–2002: regional incidence and case fatality rates. J Neurol Neurosurg Psychiatry 2008;79:294–299.
65.
Inagawa T, Hirano A: Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 1990;34:361–365.
66.
Inagawa T, Hada H, Katoh Y: Unruptured intracranial aneurysms in elderly patients. Surg Neurol 1992;38:364–370.
67.
Pechlivanis I, Harders A, Tüttenberg J, Barth M, Schulte-Altedorneburg G, Schmieder K: Computed tomographic angiography: diagnostic procedure of choice in the management of subarachnoid hemorrhage in the elderly patient? Cerebrovasc Dis 2009;28:481–489.
68.
Inagawa T: Timing of admission and management outcome in patients with subarachnoid hemorrhage. Surg Neurol 1994;41:268–276.
69.
Inagawa T: Effect of ultra-early referral on management outcome in subarachnoid haemorrhage. Acta Neurochir (Wien) 1995;136:51–61.
70.
Otani N, Takasato Y, Masaoka H, Hayakawa T, Yoshino Y, Yatsushige H, Miyawaki H, Sumiyoshi K, Chikashi A, Takeuchi S. Suzuki G: Surgical outcome following decompressive craniectomy for poor-grade aneurysmal subarachnoid hemorrhage in patients with associated massive intracerebral or Sylvian hematomas. Cerebrovasc Dis 2008;26:612–617.
71.
Komotar RJ, Hahn DK, Kim GH, Khandji J, Mocco J, Mayer SA, Connolly ES Jr: The impact of microsurgical fenestration of the lamina terminalis on shunt-dependent hydrocephalus and vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 2008;62:123–134.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.