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Definition of MirANUncommonUncommon，special subgroup of mutiple intracranial special subgroup of mutiple intracranial aneurysms;occuring at roughly the same location on aneurysms;occuring at roughly the same location on each side in the same patient without considering the each side in the same patient without considering the size of the aneurysms.size of the aneurysms.Definition of MirANUncommon，s1Hypothesis on genesis and growth of MirANs A different etiologic process occurs in mirror aneurysm disease.A congenital predisposition,and the early embryological derangement of vascular wall formation might be one of their underlying causes.Early rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Hemodynamic forces might be responsible for triggering the development of an aneurysm in the primarily abnormal vessel wall.Hypothesis on genesis and gro2Epidemiology of MirANsPrevalence:Constitute less than 5%of overall aneurysms Account for approximately 20%30%among multiple aneurysms Familial and twin intracranial aneurysm:6570%Non-familial,sporadic intracranial aneurysm:21%Our result from 190 patients harboring mutiple intracranial aneurysms between June 2007 and July 2011 MANs account for 26.3%among multiple aneurysms Epidemiology of MirANsPrevalen3Epidemiology of MirANLocation Common location:MCA bifurcation and PCoA reported by literatureUncommon site:ACA A1,Pericallosal,Vertebral Artery Our result from 50 patients with MirAN between June 2007 and July 2011 MCA bifurcation(10%)PCoA/C7(24%)C6(24%)C5(20%)C4(20%)Other location(2%)Epidemiology of MirANLocation 4Epidemiology of MirANsGender distribution MirAN VS nMirANs with mutiple intracranial aneurysms-Female/male ratio:3.1:1 VS 2.1:1 Female/male ratio of MirANs and nMirANs increased with the age 60-years MirANs VS nMirANs:7:1 VS 9:1Our result from 50 patients with MirAN between June 2007 and July 2011 Female/male ratio:2.3:1 Epidemiology of MirANsGender d5Epidemiology of MirANsAverage age at presentation/rupture for MirANs and nMirANs patients was in the 5th decade Women presented later than men in MirANs and nMirANsOur result from 50 patients with MirANs Mean age of MirANs presentation：62.412.5 years Women vs Men for MirANs：62.112.3 vs 6313.4 (P0.05)SAH occurred in 13 of 30 intracranial MirAn patients(43.3%).Average age of patients with ruptured MirANs:62.79.9 Casimiro,MV，et al .Surg Neurol,2004;61:5415Epidemiology of MirANsAverage 6Epidemiology of MirANsRisk factors Cigarette Smoking Mean age at presentation for MirAns vs nMirAns:53.39.1 vs 48.711.7 Peak age of rupture for MirAns vs nMirAns:the start of the 5th decade vs the start of the 6th decade Hypertension Mean age at presentation in MirAns vs nMirAns:58.79.2 vs 5610.4Hypertension was the most prevalent risk factor in patients presented after 60-years old;62.5%in MirAns,and 30%in nMirAns (P0.05)No known extrinsic risk factorsThe age pattern of presentation and rupture were different between MirAn and nMirAn without recognized risk factors.No known extrinsic risk factors was the main characteristic of the subset of MirAn patients 40 years.Casimiro,MV，et al .Surg Neurol,2004;61:5415Epidemiology of MirANsRisk fa7suit for one stage operation,the duty aneurysm should beUncommon，special subgroup of mutiple intracranial aneurysms;occuring at roughly the same location on each side in the same patient without considering the size of the aneurysms.Post-embolization 40-years MirANs VS nMirANs:1.Aneurysm morphologyHBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.Mean age of MirANs presentation：62.Hematoma site/the most thick site of SAHUncommon，special subgroup of mutiple intracranial aneurysms;occuring at roughly the same location on each side in the same patient without considering the size of the aneurysms.3%among multiple aneurysmsOur result from 50 patients with MirAN between June 2007 and July 20115:1 VS 1:1A congenital predisposition,and the early embryological derangement of vascular wall formation might be one of their underlying causes.Age pattern of disease presentation for the general MirAN population and for the risk factorspatients was in the 5th decadethe start of the 6th decadeHypothesis on genesis and growth of MirANs type:incomplete symmetryCasimiro,MV，et al .Age pattern of disease presentation for the general MirAN population and for the risk factors HBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.suit for one stage operation,8Age pattern of disease presentation for the general no-MirAN population and for the risk factors HBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.Age pattern of disease present9Relative prevalence of each risk factor by age group in MirAn HBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.Relative prevalence of each ri10suit for one stage operation,the duty aneurysm should beCommon location:40-years MirANs VS nMirANs:1.No known extrinsic risk factors5:1 VS 1:1 type:incomplete symmetryHBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.Our result from 50 patients with MirANsEarly rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with MirAN.Our result from 50 patients with MirAN between June 2007 and July 2011Other location(2%)Familial and twin intracranial aneurysm:6570%Pre-embolizationAge pattern of disease presentation for the general MirAN population and for the risk factorsPre-embolizationsuit for one stage operation,the duty aneurysm should beTherapeutic decision-making on MirANsIf treatment is performed,the one stage operation or twoGender distributionsuit for one stage operation,the duty aneurysm should beRisk factorsPost-embolizationRelative prevalence of each risk factor by age group in nMirAnHBP=High blood pressure,S=Cigarette smoking,and nRF=No known extrinsic risk factors.suit for one stage operation,11MirANs diagnosis approaches MirANs diagnosis approaches MRA CTA DSA MirANs were Classified as 2 type:MirANs were Classified as 2 type:type:complete symmetry type:complete symmetry type:incomplete symmetry type:incomplete symmetry MirANs diagnosis and classification MirANs diagnosis approaches M12Identification of duty lesion on MirANsCT/MRI Hematoma site/the most thick site of SAH CTA/MRA/DSA Aneurysm size Aneurysm morphology Parent artery and/or adjacent artery spasm Identification of duty les13 type MirANs type MirANs type MirANs 14 type MirANs type MirANs type MirANs15Therapeutic decision-making on MirANs Whether intracranial unruptured MirANs should be treated?Depend on the well known factors such as age of the patient,localization and size of the aneurysm.should be discussed with the affected patient on an individual basis.If treatment is considered,which choice of treatment should be employed,surgical clipping or endovascualr treatment?Depend on the location and aneurysm featuresIf treatment is performed,the one stage operation or two stage operation was choose.The first choice is one stage operation,but if the patient is not suit for one stage operation,the duty aneurysm should be treated firstTherapeutic decision-making on16Case 1 M,64 Y,progressive enlargement of incidently found aneurysmCase 1 M,64 Y,progress17Pre-embolization Post-embolization Pre-embolization Post-emboliza18Pre-embolization Post-embolization Pre-embolization Post-emboliza19Case 2 F,57 Y,SAH LRLRCase 2 F,57 Y,SAH LR20RLRL21MANs account for 26.Age pattern of disease presentation for the general MirAN population and for the risk factorsHypertensionRisk factorsA different etiologic process occurs in mirror aneurysm disease.Other location(2%)Familial and twin intracranial aneurysm:6570%Epidemiology of MirANsAneurysm morphologyOur result from 50 patients with MirANsHypertensionpatients was in the 5th decadeAge pattern of disease presentation for the general no-MirAN population and for the risk factorsRisk factorspatients was in the 5th decadeSurg Neurol,2004;61:5415Constitute less than 5%of overall aneurysms60-years old;62.Aneurysm sizethe start of the 6th decadeDepend on the location and aneurysm featuresNo known extrinsic risk factorsPre-embolization Post-embolization LLMANs account for 26.Pre-embol22Pre-embolization Post-embolization Pre-embolization Post-emboliza23
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