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Presentation and Natural History

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Introduction to Vascular Neurosurgery


Intracranial aneurysms (IAs) are prevalent in as many as 3% of the population and can present in living patients asymptomatically after incidental imaging or in a clinical presentation with headache, neurological signs, and symptoms up to and including coma. There are several risk factors underlying the formation, progression, and rupture of intracranial aneurysms. With recent advances in technology, multiple treatment options exist for IAs, with treatment options and timing differing depending on the mode of patient presentation. Careful assessment of the risk of progression and rupture of IAs, weighed against risks of intervention (either surgical clipping or endovascular treatment), should guide management. A thorough understanding of the natural history of IAs is therefore very helpful. This chapter discusses the clinical presentation and natural history of intracranial aneurysms.

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  1. Jung K-H. New pathophysiological considerations on cerebral aneurysms. Neurointervention. 2018;13(2):73–83.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Broderick JP, Brown RD, Sauerbeck L, et al. Greater rupture risk for familial as compared to sporadic unruptured intracranial aneurysms. Stroke. 2009;40(6):1952–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Unruptured intracranial aneurysms — risk of rupture and risks of surgical intervention. N Engl J Med. 1998;339(24):1725–33.

  4. Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol. 2016;12(12):699–713.

    Article  PubMed  Google Scholar 

  5. Weir B. Unruptured intracranial aneurysms: a review. J Neurosurg. 2002;96(1):3–42.

    Article  PubMed  Google Scholar 

  6. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474–82.

  7. Alessandro C, Emanuele P, Roberto DB, Silvia TC, Giusepp B. Clinical presentation of cerebral aneurysms. Eur J Radiol. 2013;82(10):1618–22.

    Article  Google Scholar 

  8. Gilard V, Grangeon L, Guegan-Massardier E, et al. Headache changes prior to aneurysmal rupture: a symptom of unruptured aneurysm? Neurochirurgie. 2016;62(5):241–4.

    Article  CAS  PubMed  Google Scholar 

  9. Kong DS, Hong SC, Jung YJ, Kim JS. Improvement of chronic headache after treatment of unruptured intracranial aneurysms. Headache. 2007;47(5):693–7.

    Article  PubMed  Google Scholar 

  10. Burkhardt JK, Winkler EA, Lasker GF, Yue JK, Lawton MT. Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms. J Neurosurg. 2018;128(6):1830–8.

    Article  PubMed  Google Scholar 

  11. Lv X, Ge H, He H, Jiang C, Li Y. Anterior inferior cerebellar artery aneurysms: segments and results of surgical and endovascular managements. Interv Neuroradiol. 2016;22(6):643–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Park W, Park JC, Han K, Ahn JS, Kwun BD. Anterior optic pathway compression due to internal carotid artery aneurysms: neurosurgical management and outcomes. J Stroke. 2015;17(3):344–53.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Qureshi AI, Mohammad Y, Yahia AM, et al. Ischemic events associated with unruptured intracranial aneurysms: Multicenter clinical study and review of the literature. Neurosurgery. 2000;46(2):282–90.

    Article  CAS  PubMed  Google Scholar 

  14. Zacharia BE, Hickman ZL, Grobelny BT, et al. Epidemiology of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2010;21(2):221–33.

    Article  PubMed  Google Scholar 

  15. Linn FHH, Rinkel GJE, Algra A, Van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke. 1996;27(4):625–9.

    Article  CAS  PubMed  Google Scholar 

  16. Huang J, Van Gelder JM, Haines SJ, et al. The probability of sudden death from rupture of intracranial aneurysms: a meta-analysis. Neurosurgery. 2002;51(5):1101–7.

    Article  PubMed  Google Scholar 

  17. Linn FHH, Wijdicks EFM, van Gijn J, Weerdesteyn-van Vliet FAC, van der Graaf Y, Bartelds AIM. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994;344(8922):590–3.

    Article  CAS  PubMed  Google Scholar 

  18. Butzkueven H, Evans AH, Pitman A, et al. Onset seizures independently predict poor outcome after subarachnoid hemorrhage. Neurology. 2000;55(9):1315–20.

    Article  CAS  PubMed  Google Scholar 

  19. Biesbroek JM, Rinkel GJE, Algra A, Van Der Sprenkel JWB. Risk factors for acute subdural hematoma from intracranial aneurysm rupture. Neurosurgery. 2012;71(2):264–8.

    Article  PubMed  Google Scholar 

  20. Brown RD, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol. 2014;13(4):393–404.

    Article  PubMed  Google Scholar 

  21. Alg VS, Sofat R, Houlden H, Werring DJ. Genetic risk factors for intracranial aneurysms: a meta-analysis in more than 116,000 individuals. Neurology. 2013;80(23):2154–65.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Molenberg R, Aalbers MW, Mazuri A, et al. UIATS as a predictor of aneurysm growth or rupture. Eur J Neurol. 2020;28(3).

  23. Reynolds MR, Willie JT, Zipfel GJ, Dacey RG. Sexual intercourse and cerebral aneurysmal rupture: potential mechanisms and precipitants: a review. J Neurosurg. 2011;114(4):969–77.

    Article  PubMed  Google Scholar 

  24. Gross BA, Rosalind Lai PM, Frerichs KU, Du R. Aspirin and aneurysmal subarachnoid hemorrhage. World Neurosurg. 2014;82(6):1127–30.

    Article  PubMed  Google Scholar 

  25. Hasan DM, Mahaney KB, Brown RD, et al. Aspirin as a promising agent for decreasing incidence of cerebral aneurysm rupture. Stroke. 2011;42(11):3156–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Wiebers DO. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.

    Article  PubMed  Google Scholar 

  27. Lall RR, Eddleman CS, Bendok BR, Batjer HH. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data. Neurosurg Focus. 2009;26(5):1–7.

    Article  Google Scholar 

  28. Greving JP, Wermer MJH, Brown RD, et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol. 2014;13(1):59–66.

    Article  PubMed  Google Scholar 

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Correspondence to Kurt Yaeger .

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Yaeger, K., Tabani, H., Bederson, J. (2022). Presentation and Natural History. In: Mascitelli, J.R., Binning, M.J. (eds) Introduction to Vascular Neurosurgery. Springer, Cham.

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