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Intracranial Aneurysm: Diagnostic Monitoring, Current Interventional Practices, and Advances

  • Jason A. Ellis
  • Erez Nossek
  • Annick Kronenburg
  • David J. Langer
  • Rafael A. OrtizEmail author
Vascular Disease (M Weinberg, Section Editor)
  • 204 Downloads
Part of the following topical collections:
  1. Topical Collection on Vascular Disease

Abstract

Purpose of review

Cerebral aneurysms are commonly diagnosed incidentally with non-invasive neuro-imaging modalities (i.e., brain MRA and/or head CTA). The first decision to be made in the management of patients with unruptured cerebral aneurysms is to determine if the aneurysm should undergo treatment as any intervention carries a risk of morbidity and mortality.

Recent findings

The multiple risk factors that are associated with increased risk of aneurysm rupture should be evaluated (size, shape, and location of aneurysm; history of hypertension and cigarette smoking and family history of cerebral aneurysms). With the advent and rapid evolution of less traumatic neuro-endovascular surgery techniques in the past two decades, many more patients are undergoing treatment of cerebral aneurysms. The neuro-endovascular surgeon has multiple options for the treatment of aneurysms including coiling, with or without balloon/stent assistance, and flow diversion. A number of intrasaccular devices for the neuro-endovascular treatment of cerebral aneurysms are being evaluated. The percentage of patients with cerebral aneurysms treated with craniotomy and clip ligation is decreasing. This is controversial as it has direct impact in neurosurgical training and the aneurysms that are usually recommended for microsurgical clipping are the ones with challenging anatomy that cannot be treated safely with endovascular approaches.

Summary

The best outcomes are achieved with management by experienced, high-volume practitioners at specialized cerebrovascular treatment centers that consist of individuals with dedicated training in neuro-endovascular surgery as well as individuals trained in open cerebrovascular neurosurgery.

Keywords

Cerebral aneurysm Coiling Clipping Flow diversion 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jason A. Ellis
    • 1
  • Erez Nossek
    • 1
    • 2
  • Annick Kronenburg
    • 3
  • David J. Langer
    • 1
  • Rafael A. Ortiz
    • 1
    Email author
  1. 1.Department of Neurosurgery, Zucker School of Medicine at Hofstra/NorthwellLenox Hill HospitalNew YorkUSA
  2. 2.Division of NeurosurgeryMaimonides Medical CenterBrooklynUSA
  3. 3.Department of Neurology and Neurosurgery, Brain Center Rudolf MagnusUMC UtrechtUtrechtThe Netherlands

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