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Unruptured Intracranial Aneurysm


Affiliations
1 Deputy Nursing Officer, Sri Ramakrishna Hospital, 395, Sarojini Naidu Road, Siddhapudur, Coimbatore – 641044., India
     

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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 sub arachnoid haemorrhage. 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 ultrasonography has been proposed as a potential modality. Treatment options include observation, endovascular coiling, and surgical clipping aneurysms.

Keywords

Sub arachnoid haemorrhage, Elderly population, Epidemiology, Intracranial aneurysms.
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  • Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol 2016; 12:699.

  • Brown RD Jr, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 2014; 13:393.

  • Rinkel GJE. Management of patients with unruptured intracranial aneurysms. CurrOpinNeurol 2019; 32:49.

  • Hackenberg KAM, Hänggi D, Etminan N. Unruptured Intracranial Aneurysms. Stroke 2018; 49:2268.

  • Ellis JA, Nossek E, Kronenburg A, et al. Intracranial Aneurysm: Diagnostic Monitoring, Current Interventional Practices, and Advances. Curr Treat Options Cardiovasc Med 2018; 20:94.

  • Vernooij MW, Ikram MA, Tanghe HL, et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357:1821.

  • Vlak MH, Algra A, Brandenburg R, Rinkel GJ. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 2011; 10:626.

  • Chien A, Liang F, Sayre J, Salamon N, Villablanca P, Viñuela F. 2013. Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms. J Neurosurg. 119:190–197

  • Clarke G, Mendelow AD, Mitchell P. 2005. Predicting the risk of rupture of intracranial aneurysms based on anatomical location. Acta Neurochir (Wien). 147:259– 63; discussion 263.

  • David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S. 1999. Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg. 91(3):396-401.

  • Davies JM, & Lawton MT (2014). Advances in Open Microsurgery for Cerebral Aneurysms. Neurosurgery, 74, S7–S16.

  • Friedman JA, Pichelmann MA, Piepgras DG, et al. 2001. Ischemic complications of surgery for anterior choroidal artery aneurysms. JNeurosurg. 94(4):565-572.

  • Friedman, J. A., & Kumar, R. (2009). Intraoperative angiography should be standard in cerebral aneurysm surgery. BMC surgery, 9, 7.

  • Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007;369(9558):306–318

  • Guglielmi detachable coiling for intracranial aneurysms: the story so far. 2001. Dovey Z, Misra M, Thornton J, Charbel FT, Debrun GM, Ausman JI. Arch Neurol. 58(4):559-64.

  • Grasso G, &Perra G. 2015. Surgical management of ruptured small cerebral aneurysm: Outcome and surgical notes. SurgNeurol Int. 6():185.

  • Hauck EF, Wohlfeld B, Welch BG, White JA, Samson D. 2008. Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study. J Neurosurg. 109(6):1012-8.

  • Hop JW, Rinkel GJ, Algra A, van Gijn J. 1997. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 28:660–4.

  • Jing Z, Ou S, Ban Y, Tong Z, Wang Y. 2010. Intraoperative assessment of anterior circulation aneurysms using the indocyanine green video angiography technique. J Clin Neurosci 17:26– 28.

  • Juvela S, Poussa K, Lehto H, Porras M. 2013. Natural history of unruptured intracranial aneurysms: a long-term follow-up study. Stroke. 44(9):2414-21. Keedy A. 2006. An overview of intracranial aneurysms. McGill J Med. 9(2):141–146.

  • Khurana VG, Seow K, Duke D. 2010. Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian Neurosurgical Experience. Br J Neurosurg. 24(2):163-172.

  • Kim YB, Hong CK, Chung J, Joo JY, Huh SK. 2014. Long-term clinical and angiographic outcomes of wrap-clipping strategies for unclippable cerebral aneurysms. Yonsei Med J. 55(2):401-9.

  • King JT Jr, Berlin JA, Flamm ES. 1994. J Neurosurg. Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a metaanalysis. 81(6):837-42.

  • Korja M, Lehto H, Juvela S. 2014. Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective Finnish cohort study. Stroke. 45:1958–1963.

  • Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevry G, Kouznetsov E, Raymond J. 2013. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J NeurolNeurosurg Psychiatry. 84:42–48.

  • Lin T, Fox AJ, Drake CG. 1989. Regrowth of aneurysm sacs from residual neck following aneurysm clipping. JNeurosurg. 70(4):556-560.

  • Martin NA, Bentson J, Viñuela F, Hieshima G, Reicher M, Black K, et al. 1990. Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 73:526–533.

  • Mehan, W.A., Romero, J.M., Hirsch, J.A., Sabbag, D.J., Gonzalez, R.G., Heit, J.J., Schaefer. P.W. 2014. Unruptured intracranial aneurysms conservativelyfollowed with serial CT angiography: could morphology and growth predict rupture? J. NeuroIntervent. Surg. 6:761–766.

  • Naggara ON, Lecler A, Oppenheim C, Meder JF, Raymond J. 2012. Endovascular treatment of intracranial unruptured aneurysms: a systematic review of the literature on safety with emphasis on subgroup analyses. Radiology. 263(3):828-35.

  • Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J. 2010. Radiology. 256(3):887-97.

  • Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. 2009. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 8(7):635–642.

  • Nishiyama Y, Kinouchi H, Senbokuya N, et al. 2012. Endoscopic indocyanine green video angiography in aneurysm surgery: an innovative method for intraoperative assessment of blood flow in vasculature hidden from microscopic view. JNeurosurg. 117(2):302-308.

  • Oda J, Kato Y, Chen SF, Sodhiya P, Watabe T, Imizu S., … Hirose Y. 2011. Intraoperative near-infrared indocyanine green–videoangiography (ICG–VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery. Journal of Clinical Neuroscience, 18(8), 1097–1100.

  • Pierot L &Wakhloo AK. 2013. Endovascular treatment of intracranial aneurysms: current status. Stroke. 44(7):2046-54.

  • Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V. 2003. Near-infrared indocyaninegreenvideoangiography: a new method for intraoperative assessment of vascular flow. Neurosurgery. 52(1):132-139.

  • Raaymakers TW, Rinkel GJ, Limburg M, Algra A. 1998. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke. 29(8):1531-8.

  • Riva M, Amin-Hanjani S, Giussani C, De Witte O, & Bruneau M. 2017. Indocyanine Green Videoangiography in Aneurysm Surgery: Systematic Review and Meta- Analysis. Neurosurgery, 83(2), 166–180.

  • Roessler K, Krawagna M, Dörfler A, Buchfelder M, &Ganslandt O. (2014). Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature. Neurosurgical Focus, 36(2), E7.

  • Ruan C, Long H, Sun H, He M, Yang K, Zhang H, & Mao B. 2015. Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis. British Journal of Neurosurgery, 29(4), 485–492.

  • Sato T, Bakhit M, Suzuki K, Sakuma J, Fujii M, Murakami Y et al. 2018. A Novel Intraoperative Laser Light Imaging System to Simultaneously Visualize Visible Light and Near-Infrared Fluorescence for Indocyanine Green Videoangiography. Cerebrovasc Dis Extra. 8(2):96-100.

  • Schievink WI. Intracranial aneurysms. N Engl J Med 1997; 336: 28–40.

  • Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. 2013. European stroke organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 35:93–112.

  • Szumilas. M. 2010. Explaining Odds Ratios. J. Can. Acad. Child. Adolesc. Psychiartry. 19(3):227-229.

  • Tang G, Cawley CM, Dion JE, Barrow DL. 2002. Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg. 96(6):993-9.

  • Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES et al. Torner J. (2015). Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms. Stroke, 46(8), 2368–2400.

  • Toth G, &Cerejo R. (2018). Intracranial aneurysms: Review of current science and management. Vascular Medicine, 23(3), 276–288.

  • Vlak MHM, Algra A, Brandenburg R, Rinkel GJE 2011. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: systematic review and meta-analysis. Lancet Neurol. 10(7):626–636.

  • Vlak, MHM, Rinkel, GJE, Greebe, P, Algra, A, 2013. Independent Risk Factors for Intracranial Aneurysms and Their Joint Effect: A Case-Control Study. Stroke 44:984- 987.

  • Wiebers DO, Whisnant JP, Huston J, Meissner I, Brown RD et al. Torner JC; International Study of Unruptured Intracranial Aneurysms Investigators. 2003. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 362(9378):103-10.

  • Williams LN, & Brown RD, Jr. 2013. Management of unruptured intracranial aneurysms. Neurology. Clinical practice. 3(2), 99–108.


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  • Unruptured Intracranial Aneurysm

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Authors

R. Andalammal
Deputy Nursing Officer, Sri Ramakrishna Hospital, 395, Sarojini Naidu Road, Siddhapudur, Coimbatore – 641044., India

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 sub arachnoid haemorrhage. 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 ultrasonography has been proposed as a potential modality. Treatment options include observation, endovascular coiling, and surgical clipping aneurysms.

Keywords


Sub arachnoid haemorrhage, Elderly population, Epidemiology, Intracranial aneurysms.

References