Abstract
An aneurysm is a localized pathological dilatation of a blood vessel (or of the cardiac wall) involving all layers. Various types of aneurysm exist (saccular (berry), fusiform, inflammatory/infective “mycotic” (septic), dissecting, dolichoectasia, and false aneurysms).
DSA is the gold standard in imaging and is superior over computerized tomography angiography (CTA) and magnetic resonance angiography (MRA).
Increased mechanical stress in aneurysm-prone regions triggers events that culminate in vascular dysfunction, leaving the endothelium nude from antithrombotic protection. Aneurysm formation is initiated by hemodynamically triggered endothelial dysfunction. An inflammatory response implicating several cytokines and inflammatory mediators as well as macrophages, T-cells, and mast cells ensues. Inflammatory pathways and mediators implicated in aneurysma formation and rupture are involved in endothelial dysfunction, phenotypic modulation, and loss of smooth muscle cells, macrophages, M1/M2 imbalance, leukocyte infiltration, vascular remodeling, and cell death. Various genes are associated with the formation and rupture of aneurysms.
Treatment consists of clipping (done by neurosurgeon in 30% of cases) or coiling (performed by interventional neuroradiologists in 70% of the cases). Clinical outcome is usually good; complications might include emboli, thrombosis, rupture with resultant subarachnoidal and/or intracerebral hemorrhage, obstruction of branch vessels.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Selected References
Bourcier R, Redon R, Desal H (2015) Genetic investigations on intracranial aneurysm: update and perspectives. Mediat Inflamm 42(2):67–71. https://doi.org/10.1016/j.neurad.2015.01.002
Castro MA (2013) Understanding the role of hemodynamics in the initiation, progression, rupture, and treatment outcome of cerebral aneurysm from medical image-based computational studies. ISRN Radiol 2013:602707. https://doi.org/10.5402/2013/602707
Chalouhi N, Hoh BL, Hasan D (2013) Review of cerebral aneurysm formation, growth, and rupture. Stroke 44(12):3613–3622. https://doi.org/10.1161/strokeaha.113.002390
Dorsch N (2011) A clinical review of cerebral vasospasm and delayed ischaemia following aneurysm rupture. Acta Neurochir Suppl 110(Pt 1):5–6. https://doi.org/10.1007/978-3-7091-0353-1_1
Frosen J, Tulamo R, Paetau A, Laaksamo E, Korja M, Laakso A, Niemela M, Hernesniemi J (2012) Saccular intracranial aneurysm: pathology and mechanisms. Acta Neuropathol 123(6):773–786. https://doi.org/10.1007/s00401-011-0939-3
Henkes H, Weber W (2015) The past, present and future of endovascular aneurysm treatment. Clin Neuroradiol 25(Suppl 2):317–324. https://doi.org/10.1007/s00062-015-0403-1
Lai LT, O’Neill AH (2017) History, evolution, and continuing innovations of intracranial aneurysm surgery. World Neurosurg 102:673–681. https://doi.org/10.1016/j.wneu.2017.02.006
Li MH, Li YD, Gu BX, Cheng YS, Wang W, Tan HQ, Chen YC (2014) Accurate diagnosis of small cerebral aneurysms </=5 mm in diameter with 3.0-T MR angiography. Radiology 271(2):553–560. https://doi.org/10.1148/radiol.14122770
McFadden JT (2012) Magnetic resonance imaging and aneurysm clips. J Neurosurg 117(1):1–11. https://doi.org/10.3171/2012.1.jns111786
Menke J, Larsen J, Kallenberg K (2011) Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol 69(4):646–654. https://doi.org/10.1002/ana.22270
Numminen J, Tarkiainen A, Niemela M, Porras M, Hernesniemi J, Kangasniemi M (2011) Detection of unruptured cerebral artery aneurysms by MRA at 3.0 tesla: comparison with multislice helical computed tomographic angiography. Acta Radiol 52(6):670–674. https://doi.org/10.1258/ar.2011.100421
Pritz MB (2011) Cerebral aneurysm classification based on angioarchitecture. J Stroke Cerebrovasc Dis 20(2):162–167. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.11.018
Raabe A, Seidel K (2016) Prevention of ischemic complications during aneurysm surgery. J Neurosurg Sci 60(1):95–103
Sadasivan C, Fiorella DJ, Woo HH, Lieber BB (2013) Physical factors effecting cerebral aneurysm pathophysiology. Ann Biomed Eng 41(7):1347–1365. https://doi.org/10.1007/s10439-013-0800-z
Sailer AM, Wagemans BA, Nelemans PJ, de Graaf R, van Zwam WH (2014) Diagnosing intracranial aneurysms with MR angiography: systematic review and meta-analysis. Stroke 45(1):119–126. https://doi.org/10.1161/strokeaha.113.003133
Sawyer DM, Amenta PS, Medel R (2015) Inflammatory mediators in vascular disease: identifying promising targets for intracranial aneurysm research. Mediators Inflamm 2015:896283. https://doi.org/10.1155/2015/896283
Sorenson T, Lanzino G (2016) Trials and tribulations: an evidence-based approach to aneurysm treatment. J Neurosurg Sci 60(1):22–26
Starke RM, Chalouhi N, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, Koch WJ, Dumont AS (2013) The role of oxidative stress in cerebral aneurysm formation and rupture. Curr Neurovasc Res 10(3):247–255
Starke RM, Chalouhi N, Ding D, Raper DM, McKisic MS, Owens GK, Hasan DM, Medel R, Dumont AS (2014a) Vascular smooth muscle cells in cerebral aneurysm pathogenesis. Transl Stroke Res 5(3):338–346. https://doi.org/10.1007/s12975-013-0290-1
Starke RM, Raper DM, Ding D, Chalouhi N, Owens GK, Hasan DM, Medel R, Dumont AS (2014b) Tumor necrosis factor-alpha modulates cerebral aneurysm formation and rupture. Transl Stroke Res 5(2):269–277. https://doi.org/10.1007/s12975-013-0287-9
Theodotou CB, Snelling BM, Sur S, Haussen DC, Peterson EC, Elhammady MS (2017) Genetic associations of intracranial aneurysm formation and sub-arachnoid hemorrhage. Asian J Neurosurg 12(3):374–381. https://doi.org/10.4103/1793-5482.180972
Tromp G, Weinsheimer S, Ronkainen A, Kuivaniemi H (2014) Molecular basis and genetic predisposition to intracranial aneurysm. Ann Med 46(8):597–606. https://doi.org/10.3109/07853890.2014.949299
Tsyben A, Paldor I, Laidlaw J (2016) Cerebral vasospasm and delayed ischaemic deficit following elective aneurysm clipping. J Clin Neurosci 34:33–38. https://doi.org/10.1016/j.jocn.2016.06.006
Tulamo R, Frosen J, Hernesniemi J, Niemela M (2010) Inflammatory changes in the aneurysm wall: a review. J Neurointerv Surg 2(2):120–130. https://doi.org/10.1136/jnis.2009.002055
Turjman AS, Turjman F, Edelman ER (2014) Role of fluid dynamics and inflammation in intracranial aneurysm formation. Circulation 129(3):373–382. https://doi.org/10.1161/circulationaha.113.001444
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer-Verlag GmbH Austria, part of Springer Nature
About this chapter
Cite this chapter
Weis, S. et al. (2019). Vascular Disorders: Aneurysms. In: Imaging Brain Diseases. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1544-2_21
Download citation
DOI: https://doi.org/10.1007/978-3-7091-1544-2_21
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-1543-5
Online ISBN: 978-3-7091-1544-2
eBook Packages: MedicineMedicine (R0)