Overview
Summary
Intracranial aneurysms are focal dilatations of the cerebral arterial wall, classically saccular and arising at branching points around the circle of Willis. They form through haemodynamic stress and inflammatory wall remodelling; dissecting, infectious and other non-saccular types arise from distinct wall diseases. Most unruptured aneurysms remain asymptomatic; CT and MR angiography approach digital subtraction angiography (DSA), the reference standard, and rupture causes aneurysmal subarachnoid haemorrhage (aSAH). Each clinical state has a page: Unruptured intracranial aneurysms, Aneurysmal subarachnoid haemorrhage, Cerebral vasospasm & delayed cerebral ischaemia after aSAH, and Endovascular aneurysm treatment: devices and techniques. European guidance suggests repair, microsurgical or endovascular, in high-volume centres, with a multidisciplinary decision for unruptured aneurysms.
Takeaways
- 1
Treat an intracranial aneurysm as a sign of lifelong vessel-wall disease, and look beyond the index aneurysm.
- 2
Refer repair decisions to a multidisciplinary team at a high-volume neurovascular centre, following European guidance.
- 3
Identify dissecting, blister, infectious and giant aneurysms before planning treatment, because their type changes the plan.
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Summary
Intracranial aneurysms are focal dilatations of the cerebral arterial wall, classically saccular and arising at branching points around the circle of Willis. They form through haemodynamic stress and inflammatory wall remodelling; dissecting, infectious and other non-saccular types arise from distinct wall diseases. Most unruptured aneurysms remain asymptomatic; CT and MR angiography approach digital subtraction angiography (DSA), the reference standard, and rupture causes aneurysmal subarachnoid haemorrhage (aSAH). Each clinical state has a page: Unruptured intracranial aneurysms, Aneurysmal subarachnoid haemorrhage, Cerebral vasospasm & delayed cerebral ischaemia after aSAH, and Endovascular aneurysm treatment: devices and techniques. European guidance suggests repair, microsurgical or endovascular, in high-volume centres, with a multidisciplinary decision for unruptured aneurysms.
Takeaways
- 1
Treat an intracranial aneurysm as a sign of lifelong vessel-wall disease, and look beyond the index aneurysm.
- 2
Refer repair decisions to a multidisciplinary team at a high-volume neurovascular centre, following European guidance.
- 3
Identify dissecting, blister, infectious and giant aneurysms before planning treatment, because their type changes the plan.