• Zimelewicz ObermanDanDDepartment of Neurosurgery, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil. Electronic address: danzoberman@gmail.com., Manuel Sliman Perez Akly, Nicollas Nunes Rabelo, Cristina Elizondo, Jorge Luiz Amorim Correa, Pablo Ajler, and Matteo Maria Baccanelli.
• Department of Neurosurgery, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil. Electronic address: danzoberman@gmail.com.
• World Neurosurg. 2021 Oct 1; 154: e155-e162.

BackgroundIntracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries.MethodsA cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries.ResultsA total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture.ConclusionsOur results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.Copyright © 2021 Elsevier Inc. All rights reserved.

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