No abstract

According the authors' experience, the emphasis of treatment for cerebral AVMs has now shifted from surgical resection to endovascular embolization. One of the explanations is that endovascular techniques are now employed in the most difficult cases (high grade AVMs). As severe complications of endovascular embolization may also occur for low-grade malformations, the question arises whether surgery or radiosurgery should not be used first for this low-grade group even if embolization is feasible.

The authors report a series of 19 patients with one (17 cases) or two (2 cases) pericallosal aneurysms referred during the past 10 years. Of the 19 patients, 18 had a ruptured pericallosal aneurysm and one was asymptomatic. On admission two were graded I, four graded II, six graded III, and six graded IV. Of the latter group two patients died from rebleeding, and the asymptomatic patient would not undergo surgery. The 16 operated patients underwent surgery after a delay ranging from 6 to 90 days after hemorrhage (25 days on average). The delayed surgery allowed the patients to be operated on in better neurological status: seven were graded I or Ia, six graded II, three graded III, and none graded IV. The results were excellent (with resumption of their previous activity) in 11 cases (69%), good (autonomous but with a slight deficit) in 4 cases (25%), and bad in 1 case (6%). There was no operative mortality or morbidity.

The central nervous system is an immunologically active environment where several components of the immune and inflammatory response interact among them and with the constituents of nervous tissue and vasculature in a critically orchestrated manner, influencing physiologic and pathologic processes. In particular, inflammation takes a central role in the pathogenesis of intracranial aneurysms (IAs). The common pathway for aneurysm formation involves endothelial dysfunction and injury, a mounting inflammatory response, vascular smooth muscle cells (VSMCs) phenotypic modulation, extracellular matrix remodeling, and subsequent cell death and vessel wall degeneration. We conducted a literature review by Medline and EMBASE databases using the searching terms "IA" and "cerebral aneurysm" and further search was performed to link the search terms with the following key words: inflammation, hemodynamic(s), remodeling, macrophages, neutrophils, lymphocytes, complement, VSMCs, mast cells, cytokines, and inflammatory biomarkers. The aim of this review was to summarize the most recent and pertinent evidences regarding the articulated processes of aneurysms formation, growth, and rupture. Knowledge of these processes may guide the diagnosis and treatment of these vascular malformations, the most common cause of subarachnoid hemorrhage, which prognosis remains dismal.