Configurational changes of ruptured intracranial aneurysms at the window between pre-operative CTA and the definite clipping surgery

Background: Ruptured intracranial aneurysms may face configurational changes in size and shape resulting from extreme weakness in their wall. These configurational changes are associated with an amplified risk of rupture and surgical challenges as these aneurysms have proven to be unstable. However, to our knowledge, no previous studies have addressed the issue of configurational aneurysmal changes between the patient’s presentation (radiological images) and intraoperative findings. This paper aims to compare aneurysmal size and shape between pre-operative Computed tomography angiography and intraoperative lesion characteristics in a cohort of patients presented to our centre. Methods: A retrospective analysis was performed on cases admitted to the Neurosurgery Teaching Hospital in Baghdad, Iraq, and underwent microsurgical clipping of ruptured aneurysms. Their records were checked for aneurysmal configurational changes by comparing pre-operative radiological images and intra-operative findings. Results: Of the 275 patients, 5 cases were enrolled with aneurysmal configurational changes. Three of them were females, and two were males. The pre-operative aneurysmal shapes based on Computed tomography angiography were (3 unicyst and two conical shapes) and the range of aneurysmal size was (7-11 mm) with a mean of 9 mm. Compared to intra-operative findings, there were total aneurysmal shape changes (connected cyst in 4 patients and spherical aneurysm in one patient). The range of aneurysmal size was (7-11 mm) with a mean of 9 mm. Conclusion: Intracranial aneurysms may undergo configurational changes through the time between pre-op imaging and surgery; early detection of these changes may ensure optimal management of such cases.