الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Subarachnoid hemorrhage (SAH) is an important cause of morbidity and mortality all over the world. Unruptured cerebral aneurysm could be considered the most reliable and definite risk factor for the subarachnoid haemorrhage. The multilobed aneurysm (ML-CA) categorized as an irregular aneurysm. The aneurysmal wall irregularities considered the strongest factor of rupture. Multilobed cerebral aneurysms constitute a higher risk of rupture than unilobed aneurysms.
Cerebral angiography remains the gold standard in the evaluation of patients suffer-ing from subarachnoid hemorrhage. Complete angiographic evaluation of all cerebral arter-ies is mandatory if SAH was diagnosed. Image-based computational fluid dynamics (CFD) is becoming a promising tool to evaluate the aneurysm and its risk of rupture.
This work aimed to assess the role of integrated three-dimensional digital subtraction angiography/ computational fluid dynamics (3D-DSA/CFD) methodology in the prediction of risk and possible site of rupture of multilobed cerebral aneurysms to support the decision of either therapeutic or conservative management in the non-ruptured aneurysms.
This study was carried out on 15 patients presented with ruptured multilobed cerebral aneurysms, diagnosed by CTA and/or MRA and confirmed by DSA, and treated by open surgical clipping. The patients were 9 males (60%) and 6 females (40%), their ages were ranged between 26 to 69 years old.
All the patients were subjected to CTA and/or MRA, DSA (2d and 3d), image-based CFD simulation and open surgical clipping.
The surgical team about the ruptured area of aneurysmal geometries approved all the 15 cases.
In the present work, the most common location of ruptured multilobed aneurysms was ICA bifurcation and PComA [4 aneurysms (27%) at each]. the most commonly eval-uated aneurysmal size was less than 7 mm. The mean aneurysmal aspect ratio (AR) in the fifteen cases was 2.01. In all cases, the SR was more than 2 (100%). The mean aneurysmal bottleneck factor was more than 1.8.
The qualitative analysis of the hemodynamic properties described the physics of the aneurysmal flow. The results of the CFD simulations were compared to the intraoperative photos and showed the following: 1) The blood viscosity increased in the ruptured bleb more than the non-ruptured bleb(s). 2) The blood was more stagnant in the ruptured areas in relation to the whole aneurysm. 3) The low tendency of the blood flow to develop vorti-ces in 66.6% of the ruptured bleb(s).