Learning objectives
To understand the pathophisiology and natural history of intracraneal aneurysm
To know the role of diagnostic images
To show the patient treatment criteria
To provide comprehensive and evidence-based recommendations for endovascular management of unruptured intracranial aneurysms (UIAs)
Background
The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of UIAs.
Until 1995,
surgical clipping of the aneurysm was the only approach available.
Nowadays,the treatment of UIAs remains complex.
While for ruptured intracranial aneurysms the management are well defined by several trials,
for asymptomatic UIAs the best option is still uncertain.
PATHOPHISIOLOGY
An aneurysm is an abnormal dilatation of an artery,
arising from focal hemodynamic stress,
inflammation,
and genetic factors.
Mechanism of formation.
Aneurysm formation...
Findings and procedure details
The rationale to treat an UIA is to prevent the rupture and its consequentaneurysmal subarachnoid hemorrhage(SAH) thatcan lead to significant morbidity and mortality.
Our understanding of the natural history and treatment outcomes of cerebral aneurysms has significantly increased over the last few decades,
but choosing the optimal management for each patient requires the careful consideration of numerous medical,
clinical and anatomic factors.
CLINICAL PRESENTATION
DIAGNOSTIC IMAGING TESTS
The radiographic studies available to delineate the size and morphologic features of an intracranial aneurysm are CT angiography...
Conclusion
The life cycle of aneurysms is a complex process where the flow dynamics play a key role in the process.
The endovascular treatment may be considered a safe and effective approach of unruptured intracranial aneurysms,
considering the technical developments that allow the complete occlusion of the aneurismal sac,
also in challenging situations.
References
Olivier N.
Naggara,
MD Phil M.
White,
MD François Guilbert,
MD Daniel Roy,
MD Alain Weill,
MD Jean Raymond,
MD.
2010.
Endovascular Treatment
of Intracranial Unruptured Aneurysms: Systematic Review and Meta-Analysis of the Literature on Safety and Efficacy.
Radiology.
Volume 256: Number 3.
N Pouratian,
R J Oskouian Jr,
M E Jensen,
N F Kassell,
A S Dumont.
2006.
Endovascular management of unruptured intracranial aneurysms J Neurol Neurosurg Psychiatry.
77:572–578.
Greving JP.
El al.
2014 Development of the PHASES score for prediction of risk of...