Morphological and Hemodynamic Differences Between Aneurysmal Middle Cerebral Artery Bifurcation and Contralateral Nonaneurysmal Anatomy

Neurosurgery 81:779–786, 2017

The morphological and hemodynamic features differ between middle cerebral artery (MCA) bifurcations with and without aneurysms.

OBJECTIVE: To investigate the morphological and hemodynamic differences between aneurysmal MCA bifurcation and contralateral nonaneurysmal anatomy.

METHODS: Computed tomography angiography of 36 patients with unilateral small saccular MCA bifurcation aneurysms was evaluated. The parent–daughter angles (ϕ1 for larger branch and ϕ2 for smaller branch), bifurcation angle (ϕ = ϕ1 + ϕ2), inclination angle (γ angle), and their relationships with the MCA bifurcation locations were analyzed. Computational fluid dynamics simulation was performed in 6 cases to explore the hemodynamics influenced by the bifurcation morphology.

RESULTS: The ϕ angle was significantly higher in aneurysmal than contralateral nonaneurysmal bifurcations (160.8◦ ± 31.0◦ vs 99.0◦ ± 19.2◦, respectively; P = .000); the ϕ1, ϕ2, and γ angles were also higher. However, by regression analysis combined with MCA bifurcation locations, only the ϕ angle might be associated with the aneurysm presence (odds ratio = 1.120, 95% confidence interval = 1.059-1.185) and a ϕ angle cut-off of 124.8◦ was established. Computational fluid dynamics simulation demonstrated that flow resistance of the wider aneurysmal MCA bifurcation was significantly higher than that on the contralateral side.

CONCLUSION: A larger ϕ angle was more prevalent in aneurysmal than nonaneurysmal MCA bifurcations, and the higher flow resistance caused by the larger ϕ angle might be a potential hemodynamic factor associated with MCA aneurysm presence.

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