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Objectives: Distal anterior cerebral artery (DACA) aneurysms account for 1%-9% of all intracranial aneurysms. Microsurgical treatment is generally preferred for DACA aneurysms; however, it presents challenges owing to the anatomical complexities. Advances in neuro-interventional techniques have yielded promising results. This study aims to compare the clinical outcomes of DACA aneurysms treated with microsurgery and endovascular treatment (EVT) to elucidate the efficacy of EVT., Materials and Methods: A multicenter observational registry comprising 16 stroke centers was utilized for this study. Data was retrospectively and prospectively analyzed from 166 patients with DACA aneurysms in our database, which included 4,552 consecutive patients with ruptured or unruptured intracranial aneurysms who underwent microsurgical or endovascular treatment between January 2013 and December 2021., Results: Surgical clipping was performed in 115 patients, and 51 underwent coil embolization. The median follow-up duration was 15.3 months. No significant differences were observed in patient characteristics between the two treatment modalities. There were no differences in complication-related morbidity between the microsurgical treatment and EVT groups in either unruptured (10.5% vs. 9.1%, p=1.00) or ruptured aneurysms (5.2% vs. 6.9%, p=0.66). Coil embolization resulted in higher recurrence and retreatment rates than surgical clipping did, especially for ruptured aneurysms (2.6% vs. 27.6%, p<0.01)., Conclusions: Endovascular treatment is an alternative to microsurgery for DACA aneurysms especially in unruptured cases or the patients who have difficulty undergoing craniotomy due to their general condition, albeit with considerations for higher recurrence and retreatment rates, particularly in ruptured cases. Close follow-up is crucial for the effective management of these challenges. Further studies are needed to refine the treatment strategies for DACA aneurysms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: In China, the application of nitinol Tubridge flow diverter (TFD) has become popular for treating intracranial aneurysms (IAs). In this study, we investigated the safety outcomes of the application of TFD for treating IAs in real-world scenarios., Methods: We retrospectively analyzed aneurysms treated with TFD in 235 centers throughout China between April 2018 and April 2020. The primary endpoint was the event-free survival rate at 12 months, defined as the occurrence of morbidity (spontaneous rupture, intraparenchymal hemorrhage (IPH), ischemic stroke, and permanent cranial neuropathy) or death. Univariate and multivariate analyses were performed to assess the risk factors. A good outcome was defined as a modified Rankin Score (mRS) of 0-2., Results: We included 1281 unruptured aneurysms treated with TFD. The overall neurological morbidity and death rates after 12 months were 5.4 and 2.8%, respectively. Ischemic strokes were the most common complication (4.2%, P < 0.001). Cranial neuropathy, IPH, and spontaneous rupture occurred in 0.3%, 0.3%, and 0.5% of aneurysms, respectively. Univariate and multivariate analyses indicated that the male gender, older age, larger aneurysm diameter, and aneurysm located on BA were the independent risk factors for neurologic events. Aneurysm located on BA was the independent risk factor for ischemic strokes. Most patients (1222) had access to the mRS, and 93.2% of them achieved good outcomes., Conclusion: Treatment of IAs with TFD was associated with low morbidity and mortality, most of which were ischemic events. Large posterior aneurysms might be associated with a higher complication rate., Trial Registration: Retrospectively registered., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objective: The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between sidewall and bifurcation aneurysms in anterior circulation arteries, utilizing computational fluid dynamics as a tool for analysis., Methods: In line with the designated inclusion criteria, this study covered 160 aneurysms identified in 131 patients who received treatment at Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, China, from January 2021 to September 2022. Utilizing follow-up digital subtraction angiography (DSA) data, these cases were classified into two distinct groups: the sidewall aneurysm group and the bifurcation aneurysm group. Morphological and hemodynamic parameters in the immediate preoperative period were meticulously calculated and examined in both groups using a three-dimensional DSA reconstruction model., Results: No significant differences were found in the morphological or hemodynamic parameters of bifurcation aneurysms at varied locations within the anterior circulation. However, pronounced differences were identified between sidewall and bifurcation aneurysms in terms of morphological parameters such as the diameter of the parent vessel (D vessel ), inflow angle (θ F ), and size ratio (SR), as well as the hemodynamic parameter of inflow concentration index (ICI) (P<0.001). Notably, only the SR exhibited a significant correlation with multiple hemodynamic parameters (P<0.001), while the ICI was closely related to several morphological parameters (R>0.5, P<0.001)., Conclusions: The significant differences in certain morphological and hemodynamic parameters between sidewall and bifurcation aneurysms emphasize the importance to contemplate variances in threshold values for these parameters when evaluating the risk of rupture in anterior circulation aneurysms. Whether it is a bifurcation or sidewall aneurysm, these disparities should be considered. The morphological parameter SR has the potential to be a valuable clinical tool for promptly distinguishing the distinct rupture risks associated with sidewall and bifurcation aneurysms., (© 2024. Huazhong University of Science and Technology.)

Background: The Tubridge flow diverter (FD) (MicroPort Medical Co. Ltd., Shanghai, China) is a novel device aimed at reconstructing the parent artery and eliminating the aneurysm. Numerical simulations based on virtual FD deployment allow the assessment of the complex nature of aneurismal flow changes before the actual intervention but are demanding on computational resources. Here, we evaluate an alternative strategy of modeling FD effects for the Tubridge system using a porous medium. The goal of this study is to reduce demands on time and complexity of the simulation procedure for applications in clinical research., Methods: Ten patient-specific aneurysm models were reconstructed from retrospectively collected diagnostic 3-dimensional digital subtraction angiographic images. Virtual FDs were deployed (SolidWorks, Dassault Systems, Concord, Massachusetts, USA; Meshmixer, Autodesk, San Rafael, California, USA) and corresponding porous medium patches were constructed at the ostium with a research computational fluid dynamics prototype (Siemens Healthineers, Forchheim, Germany). Hemodynamic conditions were simulated in 2 approaches., Results: Hemodynamics inside the aneurysm based on these 2 approaches were compared. Both approaches yielded similar results. Mean wall shear stress and mean pressure of the aneurysmal wall correlated significantly (r = 0.8, r = 1.0, P < 0.05) as did mean velocity and mean pressure at a region inside the aneurysm, at the ostium and at a cross section containing the main vertex (for velocities r = 0.9; for pressures r = 1.0, P < 0.05). The use of porous medium patches reduced the preparation and simulation time together by approximately 50%., Conclusions: Using a porous medium approach yields comparable mean values for hemodynamic alterations compared to direct virtual FD simulations. Additionally, the porous medium approach greatly reduced the modeling complexity and computation time., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: For patients with aneurysmal subarachnoid hemorrhages (SAHs) and multiple intracranial aneurysms (MIAs), a simple and fast imaging method that can identify ruptured intracranial aneurysms (RIAs) may have great clinical value. We sought to use the aneurysm-specific prediction score to identify RIAs in patients with MIAs and evaluate the aneurysm-specific prediction score., Methods: Between May 2018 and May 2021, 134 patients with 290 MIAs were retrospectively analyzed. All patients had an SAH due to IA rupture. CT angiography (CTA) was used to assess the maximum diameter, shape, and location of IAs to calculate the aneurysm-specific prediction score. Then, the aneurysm-specific prediction score was applied to RIAs in patients with MIAs., Results: The IAs with the highest aneurysm-specific prediction scores had not ruptured in 17 (12.7%) of the 134 patients with 290 MIAs. The sensitivity, specificity, false omission rate, diagnostic error rate, and diagnostic accuracy of the aneurysm-specific prediction score were higher than those of the maximum diameter, shape, and location of IAs., Conclusions: The present study suggests that the aneurysm-specific prediction score has high diagnostic accuracy in identifying RIAs in patients with MIAs and SAH, but that it needs further evaluation., (© 2022. The Author(s).)

Background: To investigate the prevalence of small ruptured saccular intracranial aneurysms (sIA) in a Chinese cohort and to identify factors associated with rupture status of sIAs., Methods: Consecutive patients with confirmed sIAs by DSA from January 2015 to July 2019 were included. Demographic and aneurysmal features, including maximal diameter, location, irregularity (lobulated or with blebs), and aspect ratio (AR, defined as height divided by neck width) were recorded and analyzed. Mixed effect logistic regression was used in multivariate analysis., Results: We analyzed 1514 sIAs in a Chinese cohort of 1216 patients, including 651 ruptured and 863 unruptured sIAs. Median aneurysm size was 5.7 mm for ruptured aneurysms, with 66.1% <7 mm in maximal diameter, and 40.2% measuring <5 mm. The median PHASES score of ruptured sIAs was 5. In multivariate analysis, male sex, hypertension, locations other than the internal carotid artery, irregularity (lobulated or with blebs), and higher AR were independently associated with rupture status (OR for irregularity, 2.88, 95% CI 2.20 to 3.77, p<0.001; OR for AR, 1.12, 95% CI 1.01 to 1.24, p=0.036). However, maximal diameter was not significantly associated with rupture status (p=0.72)., Conclusions: In this cohort, ruptured sIAs were frequently smaller than 7 mm. Shape related features, such as irregularity and higher AR, were associated with the ruptured status of sIAs, irrespective of diameter. PHASES seems to be inadequate in sIA risk stratification. Shape related parameters may be further investigated in prospective studies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Intracranial aneurysms (IA) comprise a multifactorial disease with unclear physiological mechanisms. The lysyl oxidase ( LOX ) family genes ( LOX , LOX-like 1-4 ) plays important roles in extracellular matrix (ECM) reconstruction and has been investigated in terms of susceptibility to IA in a few populations. We aimed to determine whether polymorphisms in LOX family genes are associated with susceptibility to IA in a Chinese population., Methods: This case-control study included 384 patients with IA and 384 healthy individuals without IA (controls). We genotyped 27 single nucleotide polymorphisms (SNPs) of LOX family genes using the Sequenom MassARRAY ® platform. These SNPs were adjusted for known risk factors and then, odds ratios (OR) and 95% confidence intervals (CI) were evaluated using binary logistic regression analysis., Results: The result showed that LOX rs10519694 was associated with the risk of IA in recessive (OR, 3.88; 95% CI, 1.12-13.47) and additive (OR, 1.56; 95%CI, 1.05-2.34) models. Stratified analyses illustrated that LOX rs10519694 was associated with the risk of single IA in the recessive (OR, 3.95; 95%CI, 1.04-15.11) and additive (OR, 1.64; 95%CI, 1.04-2.56) models. The LOXL2 rs1010156 polymorphism was associated with multiple IA in the dominant model (OR, 1.92; 95%CI, 1.02-3.62). No associations were observed between SNPs of LOXL1 , LOXL3 , and LOXL4 and risk of IA., Conclusion: LOX and LOXL2 polymorphisms were associated with risk of single IA and multiple IA in a Chinese population, suggesting potential roles of these genes in IA. The effects of these genes on IA require further investigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Luo, Hu, Li, Liu, Hu, Dong, Liao, Zhou, Xu, Liu, Li, Yuan, Jiang and Yan.)

During intracranial aneurysm embolization with the Pipeline embolization device (PED), ischemic and hemorrhagic complications have been observed in cases among Western populations. The postmarket multicenter registry study on the embolization of intracranial aneurysms with the PED in China, i.e., the PLUS study, was performed to assess real-world predictors of complications and functional outcomes in patients treated with the PED in a Chinese population. All patients with intracranial aneurysms who underwent embolization using the PED between November 2014 and October 2019 across 14 centers in China were included. The study endpoints included preoperative and early postoperative (< 30 days) functional outcomes (modified Rankin scale [mRS] scores) and complications related to PED treatment at early postoperative and follow-up time points (3-36 months). Multivariate analysis was performed to identify risk factors for complications. A total of 1171 consecutive patients (mean age, 53.9 ± 11.4; female, 69.6% [813/1171]) with 1322 aneurysms were included in the study. Hypertension, basilar artery aneurysms, and successful deployment after adjustment or unsuccessful device deployment were found to be independent predictors of ischemic stroke, while the use of the Flex PED and incomplete occlusion immediately after treatment were protective factors. An aneurysm size > 10 mm, distal anterior circulation aneurysms, and adjunctive coiling were found to be independent predictors of delayed aneurysm rupture, distal intraparenchymal hemorrhage, and neurological compression symptoms, respectively. The rate of PED-related complications in the PLUS study was similar to that in Western populations. The PLUS study identified successful deployment after adjustment or unsuccessful device deployment and the degree of immediate postoperative occlusion as novel independent predictors of PED-related ischemic stroke in a Chinese population. ClinicalTrial.gov Identifier: NCT03831672., (© 2021. The American Society for Experimental NeuroTherapeutics, Inc.)

Intracranial aneurysm is a common life-threatening disease. Computed tomography angiography is recommended as the standard diagnosis tool; yet, interpretation can be time-consuming and challenging. We present a specific deep-learning-based model trained on 1,177 digital subtraction angiography verified bone-removal computed tomography angiography cases. The model has good tolerance to image quality and is tested with different manufacturers. Simulated real-world studies are conducted in consecutive internal and external cohorts, in which it achieves an improved patient-level sensitivity and lesion-level sensitivity compared to that of radiologists and expert neurosurgeons. A specific cohort of suspected acute ischemic stroke is employed and it is found that 99.0% predicted-negative cases can be trusted with high confidence, leading to a potential reduction in human workload. A prospective study is warranted to determine whether the algorithm could improve patients' care in comparison to clinicians' assessment.

Objectives: To build models based on conventional logistic regression (LR) and machine learning (ML) algorithms combining clinical, morphological, and hemodynamic information to predict individual rupture status of unruptured intracranial aneurysms (UIAs), afterwards tested in internal and external validation datasets., Methods: Patients with intracranial aneurysms diagnosed by computed tomography angiography and confirmed by invasive cerebral angiograph or clipping surgery were included. The prediction models were developed based on clinical, aneurysm morphological, and hemodynamic parameters by conventional LR and ML methods., Results: The training, internal validation, and external validation cohorts were composed of 807 patients, 200 patients, and 108 patients, respectively. The area under curves (AUCs) of conventional LR models 1 (clinical), 2 (clinical and aneurysm morphological), and 3 (clinical, aneurysm morphological and hemodynamic characteristics) were 0.608, 0.765, and 0.886, respectively (all p < 0.05). The AUCs of ML models using random forest (RF), multilayer perceptron (MLP), and support vector machine (SVM) were 0.871, 0.851, and 0.863, respectively. There were no difference among AUCs of conventional LR, RF, and SVM (all p > 0.05/6), while the AUC of MLP was lower than that of conventional LR (p = 0.0055)., Conclusion: Hemodynamic parameters play an important role in the prediction performance of the models. ML methods cannot outperform conventional LR in prediction models for rupture status of UIAs integrating clinical, aneurysm morphological, and hemodynamic parameters., Key Points: • The addition of hemodynamic parameters can improve prediction performance for rupture status of unruptured intracranial aneurysms. • Machine learning algorithms cannot outperform conventional logistic regression in prediction models for rupture status integrating clinical, aneurysm morphological, and hemodynamic parameters. • Models integrating clinical, aneurysm morphological, and hemodynamic parameters may help choose the optimal management.

Objective: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system., Methods: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China., Results: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment., Conclusions: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To evaluate the efficacy and usefulness of clipping procedure by lateral supraorbital approach for tiny anterior circulation aneurysms., Study Design: An observational study., Place and Duration of Study: Department of Neurosurgery, The Second Hospital of Anhui Medical University, Hefei, Anhui Province, China, from January 2013 to March 2018., Methodology: Thirty-eight patients who had suffered aneurysm rupture, resulting in subarachnoid hemorrhage, were selected. Fourty-four very small aneurysms with a maximum diameter of ≤3 mm that presented different configurations, were identified using digital subtraction angiography (DSA). Clinical data of patients, including clinical information, microsurgery procedure, procedural complications, clinical outcomes, and follow-up were analysed., Results: All ruptured aneurysms involved the anterior circulation, located in middle cerebral artery (19/38), anterior communicating artery (10/38), posterior communicating artery (6/38), anterior choroidal artery (2/38), and ophthalmic artery (1/38). Complete occlusions were achieved in all of the lesions by surgical clipping via the lateral supraorbital approach. There were no intra-procedural ruptures or procedure-related vasospasm, epilepsy, hydrocephalus. Glasgow outcome scale (GOS) scores showed that 34 patient (86.84%) had good outcomes (GOS 4-5) at the time of discharge. There was no residual neck or recurrence following computed tomography angiography (CTA) and DSA at follow-up in 20 cases., Conclusion: Surgical clipping via lateral supraorbital approach presented a low rate of adverse events related to the procedure, and was safe and effective in ruptured tiny aneurysms. Key Words: Tiny aneurysm; Surgical clipping; Clinical outcome; Lateral supraorbital approach.

Background Both meteorological factors and morphological factors are important factors to predict intracranial aneurysm rupture. This study investigated the relationship between meteorological factors and aneurysmal subarachnoid hemorrhage (aSAH). Additionally, the morphological differences between ruptured and unruptured aneurysms under these high-risk meteorological conditions were assessed. Methods and Results The records of 1751 patients with aSAH with 2124 intracranial aneurysms were retrospectively analyzed. Spearman rank correlation analysis was used to assess the risks of incident aSAH on the basis of daily meteorological data. Morphological parameters were analyzed using 1-way ANOVA tests, and significant parameters (P<0.05) were further examined using a multivariable logistic regression analysis. Daily aSAH incidence had significant negative correlations with daily mean, maximum, and minimum temperature (P<0.001) and a significant positive correlation with daily mean atmospheric pressure (P<0.001). Additionally, 58 patients with multiple aneurysms were assessed to determine morphological differences. There were significant differences in the mean values for aneurysm size, neck width, length, height, width, parent artery diameter, shape of the aneurysm, aspect ratio, size ratio, and bottleneck factor (P<0.05). The multivariable logistic regression analysis showed that aspect ratio (β=1.277, odds ratio=3.585, 95% CI, 1.588-8.090; P=0.002) was an independent risk factor for aneurysm rupture. Receiver operating characteristic curve analysis indicated that the ruptured aneurysm threshold of size was 3.45 mm and aspect ratio was 1.05. Conclusions Lower daily mean, maximum, and minimum temperatures and a higher daily mean atmospheric pressure were associated with an increased rate of aSAH. Additionally, under these meteorological conditions, the aneurysm size and aspect ratio thresholds for predicting rupture of an aneurysm may be lower.

Objective: To investigate effects of using a large-sized coil first on embolizing cerebral aneurysms compared with conventional coils., Materials and Methods: Forty-six patients with 51 saccular intracranial aneurysms who underwent embolization with a large-sized coil first were enrolled as the large-sized coil group. There were 33 female and 13 male patients with a mean age of 56.9 ± 8.8 years. The treatment modality was coiling alone in 30 aneurysms and stent-assisted coiling in 21. Meanwhile, 50 patients with 53 intracranial aneurysms who were treated with conventional-sized coils were selected as the control conventional-sized coil group, including 36 female and 14 male patients with a mean age of 54.6 ± 5.8 years. The treatment modality was coiling alone in 29 aneurysms and stent-assisted coiling in 24 aneurysms. The occlusion rate, percent packing volume, total coil number and length, and follow-up occlusion rate were compared between the 2 groups., Results: Significantly (P < 0.001) decreased percent packing volume (19.54% ± 6.44% vs. 27.39% ± 5.68%), decreased coil number (2.98 ± 1.09 vs. 6.38 ± 1.65), and length (26.20 ± 26.57 vs. 44.35 ± 35.88 cm) were achieved in the large versus the conventional coil group. At angiographic follow-up of 8 months, only 1 aneurysm (2.2%) recurred in the large coil group compared with 5 aneurysms recurrent (11.1%) in the conventional coil group., Conclusions: The use of a large-sized coil as the first one for embolizing cerebral aneurysms may be a better embolization strategy because it achieves similar initial occlusion rates, decreased packing density, decreased coil numbers and lengths, and reduced recurrence prevalence at follow-up., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Keyhole craniotomy is a minimally invasive approach for the treatment of middle cerebral artery (MCA) aneurysms. The aim of this study was to compare the clinical outcome between supraorbital keyhole approach and pterional keyhole approach (PKA) in Chinese patients with MCA aneurysm., Methods: Consecutive patients with MCA aneurysms were reviewed between January 2013 and December 2017. Efficacy and safety between PKA and supraorbital keyhole approach were compared. Poor outcome was defined as modified Rankin Scale score of 3-6 at discharge., Results: This study enrolled 260 patients; 222 (85.4%) had ruptured aneurysm, and 183 (70.4%) received PKA. The distribution of PKA in unruptured and ruptured aneurysms showed no significant difference (P > 0.05). In subgroup analyses, PKA was more likely associated with poor outcome at discharge in patients with unruptured aneurysms (odds ratio = 5.500, 95% confidence interval = 1.013-29.850, P = 0.048), whereas approach selection was not an independent factor predicting poor outcome in patients with ruptured aneurysms (P > 0.05)., Conclusions: In a Chinese population, supraorbital keyhole approach was superior to PKA in improving outcome in patients with unruptured MCA aneurysms, but the 2 approaches showed comparable outcomes at discharge in patients with ruptured aneurysms., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: We evaluated the possible relationships between serum total homocysteine and folate and Vitamin B 12 in patients with intracranial aneurysm., Methods: We enrolled consecutive patients with intracranial aneurysm from the Han population who were admitted to the hospital, as well as control subjects who received medical examination on an outpatient basis. The serum total homocysteine, folate, and Vitamin B 12 levels were measured in patients with intracranial aneurysm and the control group, and the associations between those factors were analyzed using multivariate logistic analysis., Results: A total of 140 patients with intracranial aneurysm and 140 control subjects were enrolled from July 2014 to December 2015. The mean serum total homocysteine level in the patient group (19.98 ± 10.84 µmol/L) was significantly higher than that in the control group (15.13 ± 5.55 µmol/L, P < .001). The serum total homocysteine level was negatively correlated with folate and Vitamin B 12 levels (r = -.349, P < .001; r = -.531, P < .001, respectively) in the patient group. Homocysteine had an adjusted odds ratio of 2.196 (95% confidence interval: 1.188-4.057, P = .012) for the development of intracranial aneurysm., Conclusions: The present study provides evidence regarding the association between serum total homocysteine and folate and Vitamin B 12 in patients with intracranial aneurysm. Hyperhomocysteinemia is an independent risk factor for intracranial aneurysm, and folate and Vitamin B 12 are protective against intracranial aneurysm due to their roles in regulating the metabolism of homocysteine., (Copyright © 2017. Published by Elsevier Inc.)

Purpose: Clinical decisions for treating intracranial aneurysms (IA) require integrating information in various forms and from multiple sources. We aim to establish a framework namely AneuSearch to integrate relevant information in IA management and also allow for efficient IA searching based on carefully designed criteria., Methods: The backbone of AneuSearch is an open-source three-tier DICOM image management system called DCM4Chee, which is a Java implementation for PACS. A supplementary database (AneuSearchDB) was developed to contain morphological features, hemodynamic and histological data. The relational tables in AneuSearchDB correspond to the most fundamental questions raised by neurosurgeons during IA treatment. The system was developed through collaborations between bioengineers and neurosurgeons., Results: The prototype software has been deployed to computers in a Mianyang Central Hospital in China. Currently, the system contains the data of 105 IA patients, seven hemodynamic simulation results and nine histological section images. This system was queried as per given criteria and can also provide blood flow data after running an external computational fluid dynamics software., Conclusions: The prototype software provides a novel tool to IA management. Future works include incorporating IA treatment criteria in IA rupture risk assessment.