Management of intracranial aneurysms

Abstract

Intracranial aneurysms are lesions commonly encountered by neurosurgeons, usually as a result of subarachnoid hemorrhage. The preferred treatment of these aneurysms is either surgical clipping or endovascular coiling, both of which eliminate the aneurysm from the normal circulation to prevent aneurysmal enlargement or additional hemorrhage. Despite advances over the last several decades in the understanding of intracranial aneurysms, morbidity from treatment of these lesions remains significant. This review will discuss the epidemiology, anatomy and pathophysiology, clinical and radiographic diagnosis, various treatment options, and potential complications from aneurysm treatment.

Headache Caused By an Intracranial Aneurysm in a 32-Year-Old Woman

“…6,10,16 Intracranial aneurysms are the second most common cause of hemorrhagic strokes, placing second to intracerebral hemorrhages. 10 The incidence of aneurysmal SAHs ranges from 6 to 15 per 100 000 individuals annually, 10,12,17,18 of which 80% to 90% are the result of ruptured saccular aneurysms. 10 It is estimated that 1% to 6% of the general population have unruptured aneurysms.…”

“…10 It is estimated that 1% to 6% of the general population have unruptured aneurysms. 10,[17][18][19] Intracranial aneurysms for the most part show no racial predisposition; however, they have been noted as a risk factor among individuals of Afro-Caribbean and Japanese descent. 13 Intracranial aneurysms can occur in anyone at any age, but most ruptured aneurysms occur in individuals between 35 and 65 years old, with the highest incidence rates among those between 55 and 60 years old.…”

“…13 Intracranial aneurysms can occur in anyone at any age, but most ruptured aneurysms occur in individuals between 35 and 65 years old, with the highest incidence rates among those between 55 and 60 years old. 10,18,20 Women appear to be slightly more susceptible to the development of SAHs for reasons that are unclear. 21 Approximately 60% of all ruptured aneurysms are found to occur in women.…”

“…21 Approximately 60% of all ruptured aneurysms are found to occur in women. 10,18 A familial occurrence of intracranial aneurysms is uncommon, but the risk for a ruptured aneurysm in patients who have a first-degree relative with SAH is 4 times greater than that in the general population. There is evidence that genetic factors play some part in SAHs because of the documented association with heritable connective tissue disorders, such as autosomal dominant polycystic kidney disease, Ehlers-Danlos syndrome type IV, neurofibromatosis type I, and Marfan syndrome.…”

“…17,20,22 However, patients with aortic coarctation and polycystic kidney disease are at greater risk. 10,18 Almost all intracranial aneurysms are acquired, most arise spontaneously, and some can occur after a trauma or infection. Saccular aneurysms are believed to be the result of prolonged hemodynamic stress and resultant local arterial degeneration at branch points and the bifurcations of major cerebral arteries.…”