Small Intracranial Aneurysms and Subarachnoid Hemorrhage: Is the Size Criterion for Risk of Rupture Relevant?

Daga, Karan; Taneja, Manish; Venketasubramanian, Narayanaswamy

doi:10.1159/000503094

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…The International Study of Unruptured Intracranial Aneurysms (ISUIA)-1 and ISUIA-2 proposed that there is a minor risk of rupture of intracranial aneurysms <7 mm in size, although many studies have contradicted this conclusion. 23 The International Subarachnoid Aneurysm Trial documented that 52.5% of their patients presented with aneurysms of <5 mm. 24 The most recent guidelines from the American Heart Association and the American Stroke Association for managing unruptured intracranial aneurysms recommend follow-up for small (<7), but these guidelines do not take into account the synchronous involvement of other intracranial pathologies.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Mondragón-Soto

Villanueva-Castro

Tovar-Romero

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Unruptured incidental intracranial aneurysm can coexist with pituitary adenoma, however, the occurrence is extremely rare. Timely diagnosis of asymptomatic intracranial aneurysms with pituitary adenoma may lead to planning a tailored surgical strategy to deal with both pathologies simultaneously. A case of a patient who underwent transcranial resection of a pituitary adenoma with clipping of two mirror aneurysms is reported. OBSERVATIONS A 55-year-old female presented with deterioration of visual acuity that progressed over 1 year, as well as presence of right eyelid ptosis. Magnetic resonance imaging of the head showed the presence of an intrasellar pituitary macroadenoma. Bilateral paraclinoid aneurysms were documented to be in contact with the pituitary tumor. The patient underwent surgery with simultaneous aneurysm clipping and tumor resection through a standard pterional approach with intradural clinoidectomy. The aneurysms were successfully clipped after the tumoral debulking. After clipping, the pseudocapsule was fully resected. LESSONS Various treatment options are available. Although endovascular securing of the aneurysms prior to the tumor resection would be ideal, in cases in which this resource is not readily available at all times, the surgeon must be prepared to solve pathologies with an elevated level of complexity.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Mondragón-Soto

Villanueva-Castro

Tovar-Romero

et al. 2022

Journal of Neurosurgery: Case Lessons

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“…[1] Subarachnoid hemorrhage that results from an aneurysm rupture has a mortality rate of 44%; in survivors, most will have irreversible brain damage. [2] Furthermore, rebleeding in a previously ruptured aneurysm has a mortality rate of 80%. [3] In patients with DOI: 10.1002/adma.202305868 unruptured intracranial aneurysms, the lifetime risk of hemorrhage is up to 29% in all patients and as high as 46% in patients with aneurysms that measure more than 7 mm.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Ruptured Wide‐Necked Aneurysms using a Microcatheter Injectable Biomaterial

Zhang,

Albadawi,

Fowl

et al. 2023

Advanced Materials

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Ruptured wide‐neck aneurysms (WNAs), especially in a setting of coagulopathy, are associated with significant morbidity and mortality. We show that by trapping a sub‐millimeter clinical catheter inside the aneurysm sac using a flow diverter stent (FDS), we can achieve instant hemostasis by filling the aneurysm sac using a novel biomaterial rescuing catastrophic bleeding in large animal models. Here, multiple formulations of a biomaterial comprising gelatin, nanoclay, and iohexol were developed, optimized, and extensively tested in vitro to select the lead candidate for further testing in vivo in rat, porcine and canine models of WNAs, including in a subset with aneurysm rupture. The catheter‐injectable and x‐ray visible versions of the gel embolic agent (GEA) with the optimized mechanical properties outperformed control groups, including a subset that received a clinically used liquid embolic (Onyx, Medtronic), with and without aneurysm rupture. A combinatorial approach to ruptured WNAs with GEA and FDS may change the standard of medical practice and save lives.This article is protected by copyright. All rights reserved

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Small Intracranial Aneurysms and Subarachnoid Hemorrhage: Is the Size Criterion for Risk of Rupture Relevant?

Cited by 2 publications

References 12 publications

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case

Treatment of Ruptured Wide‐Necked Aneurysms using a Microcatheter Injectable Biomaterial

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