Saif Yousif, Alexander Vile, Dwarkesh Dharmendra Barot, Charlie Cho, Ananthababu Sadasivan Pattavilakom, Rumal Jayalath
{"title":"The natural history of cerebral infundibula: A retrospective cohort study.","authors":"Saif Yousif, Alexander Vile, Dwarkesh Dharmendra Barot, Charlie Cho, Ananthababu Sadasivan Pattavilakom, Rumal Jayalath","doi":"10.7461/jcen.2024.E2024.08.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Debate exists regarding the true pathogenicity of cerebral infundibula (CI). Pre-aneurysmal lesions and benign anatomical variants have both been proposed. In this study, we present the largest single cohort series on the natural history of CI.</p><p><strong>Methods: </strong>Retrospective review of prospective surveillance of 420 CI was undertaken in a single tertiary cerebrovascular centre. All CI diagnosed by a neuroradiologist, diagnosed on either a Magnetic resonance angiography (MRA), Computed tomography angiography (CTA) or Digital subtraction angiography (DSA) were eligible for inclusion. Imaging and demographic characteristics were recorded at baseline. CI growth and aneurysm transformation were the outcomes of interest. Groupwise comparison was conducted via Fischer exact testing. Kaplan Meir curves and Cox proportional hazard ratios were used to assess variables of interest with respect to time on surveillance.</p><p><strong>Results: </strong>402 patients with 420 CI were surveyed over 2418 infundibula-years. Eleven CI (2.62%) grew on surveillance, and three (0.7%) transformed into aneurysms. Median time to growth was 85 months (36-263) and median time to aneurysm transformation was 112 months (96-142). Of the CI that grew, male sex and CI >2 mm at diagnosis were significant predictors of growth (all p<0.05). Of the CI that grew in surveillance, 2/11 (18.2%) transformed into aneurysms (p=0.001). Aneurysm transformation occurred at a rate of 1.27 per 1000 infundibula years. CI growth on surveillance (p= 0.00016) and size at diagnosis (p=0.038) remained significant predictors of aneurysm transformation on Kaplan Meir curves.</p><p><strong>Conclusions: </strong>The transformation of a CI to an aneurysm occurs at a low rate. A history of growth on surveillance imaging represents significant risk for aneurysm transformation.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cerebrovascular and endovascular neurosurgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.7461/jcen.2024.E2024.08.003","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Debate exists regarding the true pathogenicity of cerebral infundibula (CI). Pre-aneurysmal lesions and benign anatomical variants have both been proposed. In this study, we present the largest single cohort series on the natural history of CI.
Methods: Retrospective review of prospective surveillance of 420 CI was undertaken in a single tertiary cerebrovascular centre. All CI diagnosed by a neuroradiologist, diagnosed on either a Magnetic resonance angiography (MRA), Computed tomography angiography (CTA) or Digital subtraction angiography (DSA) were eligible for inclusion. Imaging and demographic characteristics were recorded at baseline. CI growth and aneurysm transformation were the outcomes of interest. Groupwise comparison was conducted via Fischer exact testing. Kaplan Meir curves and Cox proportional hazard ratios were used to assess variables of interest with respect to time on surveillance.
Results: 402 patients with 420 CI were surveyed over 2418 infundibula-years. Eleven CI (2.62%) grew on surveillance, and three (0.7%) transformed into aneurysms. Median time to growth was 85 months (36-263) and median time to aneurysm transformation was 112 months (96-142). Of the CI that grew, male sex and CI >2 mm at diagnosis were significant predictors of growth (all p<0.05). Of the CI that grew in surveillance, 2/11 (18.2%) transformed into aneurysms (p=0.001). Aneurysm transformation occurred at a rate of 1.27 per 1000 infundibula years. CI growth on surveillance (p= 0.00016) and size at diagnosis (p=0.038) remained significant predictors of aneurysm transformation on Kaplan Meir curves.
Conclusions: The transformation of a CI to an aneurysm occurs at a low rate. A history of growth on surveillance imaging represents significant risk for aneurysm transformation.
目的:关于脑底窝(CI)的真正致病性存在争议。动脉瘤前病变和良性解剖变异均被提出。在本研究中,我们展示了有关 CI 自然史的最大单个队列系列:方法:我们在一家三级脑血管中心对前瞻性监测的 420 例 CI 进行了回顾性分析。所有由神经放射科医生诊断、经磁共振血管造影(MRA)、计算机断层扫描血管造影(CTA)或数字减影血管造影(DSA)确诊的 CI 均符合纳入条件。基线时记录成像和人口统计学特征。CI增长和动脉瘤转化是研究的重点。通过费舍尔精确检验进行分组比较。Kaplan Meir曲线和Cox比例危险比用于评估与监测时间有关的相关变量:在 2418 个肺泡年中,对 402 名患者和 420 个 CI 进行了调查。11个CI(2.62%)在监测期间生长,3个(0.7%)转化为动脉瘤。生长时间中位数为 85 个月(36-263),动脉瘤转化时间中位数为 112 个月(96-142)。在增长的 CI 中,男性性别和诊断时 CI >2 mm 是增长的重要预测因素(所有 p 结论:CI转化为动脉瘤的发生率很低。监测成像中的生长史代表着动脉瘤转化的重大风险。