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Narrative Review

Vol. 9 No. 2 (2006)

An overview of intracranial aneurysms

  • Alexander Keedy
DOI
https://doi.org/10.26443/mjm.v9i2.672
Submitted
November 8, 2020
Published
2020-12-01

Abstract

Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Unruptured aneurysms may cause symptoms mainly due to a mass effect, but the real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage. Most aneurysms are asymptomatic and will not rupture, but they grow unpredictably and even small aneurysms carry a risk of rupture. Intracranial aneurysms are diagnosed and monitored with imaging including intra-arterial digital subtraction angiography, computed tomography angiography, magnetic resonance angiography, and recently transcranial Doppler ultrasonograpy has been proposed as a potential modality. Treatment options include observation, endovascular coiling, and surgical clipping. This paper will review the epidemiology, pathogenesis, clinical presentation, diagnosis, natural history, and management of unruptured saccular intracranial aneurysms.

References

  1. Rinkel GJ, Djibuti M, Algra A, et al. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29: 251-6.
  2. Gasparotti R, Liserre R. Intracranial aneurysms. Eur Radiol 2005; 15: 441-7.
  3. Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms. Brain 2000; 123: 205-21.
  4. Wagner M, Stenger K. Unruptured intracranial aneurysms: using evidence and outcomes to guide patient teaching. Crit Care Nurs Q 2005; 28: 341-54.
  5. Austin G, Fisher S, Dickson D, et al. The significance of the extracellular matrix in intracranial aneurysms. Ann Clin Lab Sci 1993; 23: 97-105.
  6. Stehbens WE, Delahunt B, Hilless AD. Early berry aneurysm formation in Marfan's syndrome. Surg Neurol 1989; 31: 200-2.
  7. Liebenberg WA, Worth R, Firth GB, et al. Aneurysmal subarachnoid haemorrhage: guidance in making the correct diagnosis Postgrad Med J 2005; 81: 470-3.
  8. Gorelick PB, Hier DB, Caplan LR, et al. Headache in acute cerebrovascular disease. Neurology 1986; 36: 1445-50.
  9. Friedman JA, Piepgras DG, Pichelmann MA, et al. Small cerebral aneurysms presenting with symptoms other than rupture. Neurology 2001; 57: 1212-6.
  10. Wiebers DO, Whisnant JP, Huston J 3rd, et al. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362: 103-10.
  11. Rowley HA. Cerebrovascular Disease. In: Brant W, Helms C. Fundamentals of Diagnostic Radiology. Baltimore, MD: Williams & Wilkins; 1994.
  12. Polmear A. Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. Cephalalgia 2003; 23: 935-41.
  13. Novelline R. The Central Nervous System. In: Novelline R. Squire's Fundamentals of Radiology, 5th ed. Cambridge, MA: Harvard University Press; 1997.
  14. Jager R, Saunders D, Murray A. Cranial and intracranial pathology (2): cerebrovascular disease and nontraumatic intracranial hemorrhage. In: Grainger R, Allison D, Adam A, Dixon A. Diagnostic Radiology: A Textbook of Medical Imaging, 4th ed. London, England: Harcourt Publishers Limited; 2001.
  15. Leffers AM, Wagner A. Neurologic complications of cerebral angiography. A retrospective study of complication rate and patient risk factors. Acta Radiol 2000; 41: 204-10.
  16. Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992; 182: 243-6.
  17. Warnock NG, Gandhi MR, Bergvall U, Powell T. Complications of intraarterial digital subtraction angiography in patients investigated for cerebral vascular disease. Br J Radiol 1993; 66 (790): 855-8.
  18. Tipper G, U-King-Im JM, Price SJ, et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography. Clin Radiol 2005; 60: 565-72.
  19. Kouskouras C, Charitanti A, Giavroglou C, et al. Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings. Neuroradiology 2004; 46: 842-50.
  20. Chappell ET, Moure FC, Good MC. Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis. Neurosurgery 2003; 52: 624-3.
  21. Turner CL, Kirkpatrick PJ. Detection of intracranial aneurysms with unenhanced and echo contrast enhanced transcranial power Doppler. J Neurol Neurosurg Psychiatry 2000; 68: 489-95.
  22. Villablanca JP, Hooshi P, Martin N, et al. Three-dimensional helical computerized tomography angiography in the diagnosis, characterization, and management of middle cerebral artery aneurysms: comparison with conventional angiography and intraoperative findings. J Neurosurg 2002; 97: 1322-32.
  23. Tummala RP, Baskaya MK, Heros RC. Contemporary management of incidental intracranial aneurysms. Neurosurg Focus 2005; 18: 9:1-7.
  24. The International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured Intracranial Aneurysms-risk of rupture and risk of surgical intervention. N Engl J Med 1998; 339: 1725-33.
  25. Turner CL, Higgins JN, Kirkpatrick PJ. Assessment of transcranial color-coded duplex sonography for the surveillance of intracranial aneurysms treated with Guglielmi detachable coils. Neurosurgery 2003; 53: 866-71.
  26. Costalat V, Lebars E, Sarry L, et al. In vitro evaluation of 2D-digital subtraction angiography versus 3D-time-of-flight in assessment of intracranial cerebral aneurysm filling after endovascular therapy. Am J Neuroradiol 2006; 27: 177-84.
  27. Molyneux A, Kerr R, Stratton I, et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360: 1267-74.

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