An overview of intracranial aneurysms
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.
- Rinkel GJ, Djibuti M, Algra A, et al. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29: 251-6.
- Gasparotti R, Liserre R. Intracranial aneurysms. Eur Radiol 2005; 15: 441-7.
- Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms. Brain 2000; 123: 205-21.
- Wagner M, Stenger K. Unruptured intracranial aneurysms: using evidence and outcomes to guide patient teaching. Crit Care Nurs Q 2005; 28: 341-54.
- 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.
- Stehbens WE, Delahunt B, Hilless AD. Early berry aneurysm formation in Marfan's syndrome. Surg Neurol 1989; 31: 200-2.
- Liebenberg WA, Worth R, Firth GB, et al. Aneurysmal subarachnoid haemorrhage: guidance in making the correct diagnosis Postgrad Med J 2005; 81: 470-3.
- Gorelick PB, Hier DB, Caplan LR, et al. Headache in acute cerebrovascular disease. Neurology 1986; 36: 1445-50.
- Friedman JA, Piepgras DG, Pichelmann MA, et al. Small cerebral aneurysms presenting with symptoms other than rupture. Neurology 2001; 57: 1212-6.
- 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.
- Rowley HA. Cerebrovascular Disease. In: Brant W, Helms C. Fundamentals of Diagnostic Radiology. Baltimore, MD: Williams & Wilkins; 1994.
- Polmear A. Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. Cephalalgia 2003; 23: 935-41.
- Novelline R. The Central Nervous System. In: Novelline R. Squire's Fundamentals of Radiology, 5th ed. Cambridge, MA: Harvard University Press; 1997.
- 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.
- 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.
- Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992; 182: 243-6.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Tummala RP, Baskaya MK, Heros RC. Contemporary management of incidental intracranial aneurysms. Neurosurg Focus 2005; 18: 9:1-7.
- 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.
- 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.
- 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.
- 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.
Download data is not yet available.