Role of aneurysmal hemodynamic changes in pathogenesis of headaches associated with unruptured cerebral aneurysms.

IF 3.5 2区医学 Q1 CLINICAL NEUROLOGY

Journal of neurosurgery Pub Date : 2024-08-30 DOI:10.3171/2024.5.JNS232490

Kornelia M Kliś, Antoni Cierniak, Borys M Kwinta, Krzysztof Stachura, Tadeusz J Popiela, Igor Szydłowski, Bartłomiej Łasocha, Jerzy Gąsowski, Roger M Krzyżewski

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引用次数: 0

Abstract

Objective: One symptom commonly associated with the presence of unruptured intracranial aneurysms is headache. In this study, the authors aimed to analyze factors associated with headaches among patients with intracranial aneurysms, with special consideration of hemodynamic parameters.

Methods: The authors prospectively included 96 patients with 122 unruptured intracranial aneurysms. The authors obtained detailed medical history including current diseases and medications, as well as blood pressure values taken during hospitalization from the patients' medical records. The short-form McGill Pain Questionnaire was administered to each patient at admission and 3-6 months after the procedure to assess type and severity of headache. Based on imaging data, the authors obtained 3D reconstruction of each patients' aneurysm dome with feeding artery. The authors performed computational fluid dynamics analysis of blood flow through prepared models using OpenFOAM. Blood was modeled as Newtonian fluid, using the incompressible transient solver. Patient-specific internal carotid artery (ICA) blood velocity waves obtained with Doppler ultrasound were set as inlet boundary conditions. After performing simulation, the authors calculated the hemodynamic parameters of the aneurysm dome.

Results: A total of 30 patients (31.25%) reported having headaches. In multivariate logistic regression analysis, female sex (OR 2.81, 95% CI 2.51-4.86; p < 0.01), ICA aneurysm location (OR 7.93, 95% CI 5.51-8.52; p < 0.01), multiple aneurysms (OR 6.05, 95% CI 1.83-11.83; p = 0.02), mean dome blood velocity (OR 3.10, 95% CI 2.01-3.30; p < 0.01) and time-averaged wall shear stress (OR 1.18, 95% CI 1.47-2.72; p = 0.04) were independently associated with the presence of headache. Additionally, 17 patients (56.67%) reported complete relief of symptoms after the procedure. In multivariate logistic regression analysis, the mean blood flow in the ICA was independently associated with complete resolution of headaches after aneurysm treatment (OR 2.32, 95% CI 1.57-3.28; p < 0.01).

Conclusions: Hemodynamic parameters of intracranial aneurysms might be associated with headaches and their relief after aneurysm treatment.

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动脉瘤血流动力学变化在与未破裂脑动脉瘤相关的头痛发病机制中的作用。

目的：头痛是未破裂颅内动脉瘤患者常见的症状之一。在这项研究中，作者旨在分析颅内动脉瘤患者头痛的相关因素，并特别考虑到血液动力学参数：作者前瞻性地纳入了 96 名患有 122 个未破裂颅内动脉瘤的患者。作者从患者的病历中获得了详细的病史，包括目前的疾病和药物，以及住院期间的血压值。每位患者在入院时和手术后 3-6 个月都接受了短式麦吉尔疼痛问卷调查，以评估头痛的类型和严重程度。根据成像数据，作者获得了每位患者动脉瘤穹顶与供血动脉的三维重建。作者使用 OpenFOAM 对通过准备好的模型的血流进行了计算流体动力学分析。使用不可压缩瞬态求解器将血液模拟为牛顿流体。多普勒超声获得的特定患者颈内动脉（ICA）血流速度波被设定为入口边界条件。进行模拟后，作者计算了动脉瘤穹顶的血流动力学参数：共有 30 名患者（31.25%）报告有头痛症状。83；p = 0.02）、平均穹隆血流速度（OR 3.10，95% CI 2.01-3.30；p < 0.01）和时间平均动脉壁剪应力（OR 1.18，95% CI 1.47-2.72；p = 0.04）与头痛的出现独立相关。此外，17 名患者（56.67%）报告称手术后症状完全缓解。在多变量逻辑回归分析中，ICA的平均血流量与动脉瘤治疗后头痛完全缓解有独立关联（OR 2.32，95% CI 1.57-3.28；P < 0.01）：颅内动脉瘤的血流动力学参数可能与头痛以及动脉瘤治疗后头痛的缓解有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgery 医学-临床神经学

CiteScore

7.20

自引率

7.30%

发文量

1003

审稿时长

1 months

期刊介绍： The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.