Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms

Kai Quan^#^{1

2

3

4

5}, Liuxun Hu^#^{1

2

3

4

5}, Shichao Zhang^#^{6

7}, Yufei Jin^{6

7}, Dongdong Wang⁸, Jianfeng Luo⁹, Yu Ma^{10

11}, Ying Mao^{12

13

14

15

16}, Wei Zhu^{17

18

19

20

21}

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
² National Center for Neurological Disorders, Shanghai, 200040, China.
³ Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
⁴ Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
⁵ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
⁶ School of Information Science and Technology, Fudan University, Shanghai, 200433, China.
⁷ Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Shanghai, 200032, China.
⁸ Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
⁹ Department of Biostatistics, School of Public Health, Fudan University, Shanghai, 200030, China.
¹⁰ School of Information Science and Technology, Fudan University, Shanghai, 200433, China. mayu@fudan.edu.cn.
¹¹ Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Shanghai, 200032, China. mayu@fudan.edu.cn.
¹² Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹³ National Center for Neurological Disorders, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁴ Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁵ Neurosurgical Institute of Fudan University, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁶ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁷ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
¹⁸ National Center for Neurological Disorders, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
¹⁹ Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
²⁰ Neurosurgical Institute of Fudan University, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
²¹ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.

^# Contributed equally.

PMID: 37857901
DOI: 10.1007/s00330-023-10303-0

Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms

Kai Quan et al. Eur Radiol. 2024 May.

. 2024 May;34(5):3009-3018.

doi: 10.1007/s00330-023-10303-0. Epub 2023 Oct 20.

Authors

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
² National Center for Neurological Disorders, Shanghai, 200040, China.
³ Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
⁴ Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
⁵ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
⁶ School of Information Science and Technology, Fudan University, Shanghai, 200433, China.
⁷ Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Shanghai, 200032, China.
⁸ Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
⁹ Department of Biostatistics, School of Public Health, Fudan University, Shanghai, 200030, China.
¹⁰ School of Information Science and Technology, Fudan University, Shanghai, 200433, China. mayu@fudan.edu.cn.
¹¹ Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Shanghai, 200032, China. mayu@fudan.edu.cn.
¹² Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹³ National Center for Neurological Disorders, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁴ Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁵ Neurosurgical Institute of Fudan University, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁶ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China. maoying@fudan.edu.cn.
¹⁷ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
¹⁸ National Center for Neurological Disorders, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
¹⁹ Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
²⁰ Neurosurgical Institute of Fudan University, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.
²¹ Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China. drzhuwei@fudan.edu.cn.

^# Contributed equally.

PMID: 37857901
DOI: 10.1007/s00330-023-10303-0

Abstract

Objective: To investigate the association between chronic headache outcome and aneurysmal wall enhancement (AWE) on high-resolution vessel wall imaging (HR-VWI) in patients with unruptured intracranial aneurysms (UIAs) who underwent microsurgical clipping.

Methods: Two hundred seventy-four UIA patients were retrospectively analyzed. Patients were grouped according to presence of AWE. AWE was subclassified as focal or uniform. Clinical and imaging data were recorded. Headache was evaluated using the 10-point numerical rating scale and Headache Impact Test-6 before and 6 months after surgery.

Results: The proportions of patients reporting chronic headache in the no AWE, focal wall enhancement (FWE), and uniform wall enhancement (UWE) groups were 5.7%, 24.8%, and 41.8%, respectively. All patients in the UWE group who reported headache before surgery experienced headache improvement after surgery. Decrease in headache severity was greater in the UWE group than in the FWE group. Multivariate binary logistic regression showed that FWE (odds ratio (OR) 0.490; 95% confidence interval (CI), 0.262-0.917; p = 0.026) and small intraluminal thrombus (OR 0.336; 95% CI, 0.142-0.795; p = 0.013) were independent factors protective against preoperative headache. FWE (OR 0.377; 95% CI, 0.195-0.728; p = 0.004) and small intraluminal thrombus (OR 0.235; 95% CI, 0.088-0.630; p = 0.004) were independent predictors of no headache relief after surgery.

Conclusions: AWE on HR-VWI is associated with relief of chronic headache after surgical clipping in patients with UIAs. Incidence of chronic headache was highest in patients exhibiting UWE. These patients also experienced the greatest improvement in headache after surgical clipping.

Clinical relevance statement: This study revealed that high-resolution vessel wall imaging can demonstrate aneurysmal wall plaque and intraluminal thrombus, which may be prognostic imaging markers for chronic headache in patients with unruptured intracranial aneurysms.

Key points: • Aneurysmal wall enhancement may be associated with chronic headache. • Incidence of chronic headache was highest in patients with aneurysms exhibiting uniform wall enhancement. • Patients with aneurysms exhibiting uniform wall enhancement experienced the greatest improvement in headache after clipping.

Keywords: Chronic headache; High-resolution vessel wall MRI; Intracranial aneurysm; Intraluminal thrombus; Microsurgery.

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References

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Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms

Affiliations

Association of preoperative aneurysmal wall enhancement with relief of chronic headache after surgical clipping of unruptured intracranial aneurysms

Authors

Affiliations

Abstract

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical