Abstract
Intracranial aneurysms are a non-exceptional disease affecting 1–3 % of the general population. The incidence of aneurysmal subarachnoid hemorrhage (SAH) is about 1/10,000/year. Aneurysmal SAH is a devastating disease leading to death approximately in 50 % of the cases and to neurological sequels in about 25 % of the cases. Management of aneurysmal SAH consists in early exclusion of the aneurysm’s sac either by endovascular means or by microsurgical clipping. Intensive care management is of tremendous importance to treat SAH-related complications like hydrocephalus and to prevent delayed complications such as vasospasm. Current perspectives for intracranial aneurysms management consist in a better selection of the unruptured aneurysms to treat, in order to propose a preventive treatment of exclusion before they bleed.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Johnston SC, Higashida RT, Barrow DL et al (2002) Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke J Cereb Circ 33:2536–2544
Bardach NS, Zhao S, Gress DR et al (2002) Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke J Cereb Circ 33:1851–1856
de Rooij NK, Linn FH, van der Plas JA et al (2007) Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365–1372
Muller TB, Sandvei MS, Kvistad KA et al (2013) Unruptured intracranial aneurysms in the Norwegian Nord-Trondelag Health Study (HUNT): risk of rupture calculated from data in a population-based cohort study. Neurosurgery 73:256–261, discussion 260; quiz 261
Caranci F, Briganti F, Cirillo L et al (2013) Epidemiology and genetics of intracranial aneurysms. Eur J Radiol 82:1598–1605
Lafuente J, Maurice-Williams RS (2003) Ruptured intracranial aneurysms: the outcome of surgical treatment in experienced hands in the period prior to the advent of endovascular coiling. J Neurol Neurosurg Psychiatry 74:1680–1684
Fraser JF, Riina H, Mitra N et al (2006) Treatment of ruptured intracranial aneurysms: looking to the past to register the future. Neurosurgery 59:1157–1166, discussion 1166–1157
Wermer MJ, van der Schaaf IC, Algra A et al (2007) Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke J Cereb Circ 38:1404–1410
(1998) Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. International study of unruptured intracranial aneurysms investigators. N Engl J Med 339:1725–1733
Bonneville F, Sourour N, Biondi A (2006) Intracranial aneurysms: an overview. Neuroimaging Clin N Am 16:371–382
Brisman JL, Song JK, Newell DW (2006) Cerebral aneurysms. N Engl J Med 355:928–939
Mizutani T, Miki Y, Kojima H et al (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259, discussion 259–260
Niemczyk M, Gradzik M, Niemczyk S et al (2013) Intracranial aneurysms in autosomal dominant polycystic kidney disease. AJNR Am J Neuroradiol 34:1556–1559
Rozenfeld MN, Ansari SA, Shaibani A et al (2014) Should patients with autosomal dominant polycystic kidney disease be screened for cerebral aneurysms? AJNR Am J Neuroradiol 35:3–9
Rinkel GJ, Djibuti M, Algra A et al (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke J Cereb Circ 29:251–256
Schievink WI (2004) Cerebrovascular involvement in Ehlers-Danlos syndrome. Curr Treat Options Cardiovasc Med 6:231–236
Schievink WI (1999) Marfan syndrome and intracranial aneurysms. Stroke J Cereb Circ 30:2767–2768
Schievink WI, Katzmann JA, Piepgras DG et al (1996) Alpha-1-antitrypsin phenotypes among patients with intracranial aneurysms. J Neurosurg 84:781–784
Ruigrok YM, Rinkel GJ (2008) Genetics of intracranial aneurysms. Stroke J Cereb Circ 39:1049–1055
Ruigrok YM, Rinkel GJ, Algra A et al (2004) Characteristics of intracranial aneurysms in patients with familial subarachnoid hemorrhage. Neurology 62:891–894
Wiebers DO, Whisnant JP, Huston J 3rd et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110
Nieuwkamp DJ, Setz LE, Algra A et al (2009) Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 8:635–642
Stapleton CJ, Walcott BP, Fusco MR, Butler WE, Thomas AJ, Ogilvy CS (2015) Surgical management of ruptured middle cerebral artery aneurysms with large intraparenchymal or sylvian fissure hematomas. Neurosurgery. 76(3):258–64
Boujemaa H, Gongora-Rivera F, Barragan-Campos H et al (2006) Bilateral acute subdural hematoma from ruptured posterior communicating artery aneurysm. A case report. Interv Neuroradiol J Peritherapeutic Neuroradiol Surg Proc Relat Neurosci 12:37–40
Feely M, Kapoor S (1987) Third nerve palsy due to posterior communicating artery aneurysm: the importance of early surgery. J Neurol Neurosurg Psychiatry 50:1051–1052
Clarencon F, Bonneville F, Boch AL et al (2011) Parent artery occlusion is not obsolete in giant aneurysms of the ICA. Experience with very-long-term follow-up. Neuroradiology 53:973–982
Roccatagliata L, Guedin P, Condette-Auliac S et al (2010) Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management. Acta Neurochir 152:2133–2142
Davies A, Dale O, Renowden S (2011) Spontaneous rupture of an intra-cavernous internal carotid artery aneurysm presenting with massive epistaxis. J Laryngol Otol 125:1070–1072
Cortnum S, Sorensen P, Jorgensen J (2010) Determining the sensitivity of computed tomography scanning in early detection of subarachnoid hemorrhage. Neurosurgery 66:900–902, discussion 903
Latchaw RE, Silva P, Falcone SF (1997) The role of CT following aneurysmal rupture. Neuroimaging Clin N Am 7:693–708
Sohn CH, Baik SK, Lee HJ et al (2005) MR imaging of hyperacute subarachnoid and intraventricular hemorrhage at 3T: a preliminary report of gradient echo T2*-weighted sequences. AJNR Am J Neuroradiol 26:662–665
Mohamed M, Heasly DC, Yagmurlu B et al (2004) Fluid-attenuated inversion recovery MR imaging and subarachnoid hemorrhage: not a panacea. AJNR Am J Neuroradiol 25:545–550
Verma RK, Kottke R, Andereggen L et al (2013) Detecting subarachnoid hemorrhage: comparison of combined FLAIR/SWI versus CT. Eur J Radiol 82:1539–1545
Sidman R, Connolly E, Lemke T (1996) Subarachnoid hemorrhage diagnosis: lumbar puncture is still needed when the computed tomography scan is normal. Acad Emerg Med 3:827–831
Davis SM, Donnan GA (2008) Thunderclap headache: CT and lumbar puncture but occasionally more! Stroke J Cereb Circ 39:1396
Cruickshank A, Auld P, Beetham R et al (2008) Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. Ann Clin Biochem 45:238–244
Marder CP, Narla V, Fink JR et al (2014) Subarachnoid hemorrhage: beyond aneurysms. AJR Am J Roentgenol 202:25–37
Geibprasert S, Pongpech S, Jiarakongmun P et al (2010) Radiologic assessment of brain arteriovenous malformations: what clinicians need to know. Radiogr Rev Publ Radiol Soc North Am Inc 30:483–501
Li Q, Lv F, Yao G et al (2014) 64-section multidetector CT angiography for evaluation of intracranial aneurysms: comparison with 3D rotational angiography. Acta Radiol 55(7):840–6
Taschner CA, Thines L, Lernout M et al (2007) Treatment decision in ruptured intracranial aneurysms: comparison between multi-detector row CT angiography and digital subtraction angiography. J Neuroradiol 34:243–249
Teksam M, McKinney A, Casey S et al (2004) Multi-section CT angiography for detection of cerebral aneurysms. AJNR Am J Neuroradiol 25:1485–1492
Zhang H, Hou C, Zhou Z et al (2012) Evaluating of small intracranial aneurysms by 64-detector CT angiography: a comparison with 3-dimensional rotation DSA or surgical findings. J Neuroimag Off J Am Soc Neuroimag
Luo Z, Wang D, Sun X et al (2012) Comparison of the accuracy of subtraction CT angiography performed on 320-detector row volume CT with conventional CT angiography for diagnosis of intracranial aneurysms. Eur J Radiol 81:118–122
Yanamadala V, Sheth SA, Walcott BP et al (2013) Non-contrast 3D time-of-flight magnetic resonance angiography for visualization of intracranial aneurysms in patients with absolute contraindications to CT or MRI contrast. J Clin Neurosci 20:1122–1126
Missler U, Hundt C, Wiesmann M et al (2000) Three-dimensional reconstructed rotational digital subtraction angiography in planning treatment of intracranial aneurysms. Eur Radiol 10:564–568
Hui FK, Tumialan LM, Tanaka T et al (2009) Clinical differences between angiographically negative, diffuse subarachnoid hemorrhage and perimesencephalic subarachnoid hemorrhage. Neurocrit Care 11:64–70
Lin N, Zenonos G, Kim AH et al (2012) Angiogram-negative subarachnoid hemorrhage: relationship between bleeding pattern and clinical outcome. Neurocrit Care 16:389–398
Dalyai R, Chalouhi N, Theofanis T et al (2013) Subarachnoid hemorrhage with negative initial catheter angiography: a review of 254 cases evaluating patient clinical outcome and efficacy of short- and long-term repeat angiography. Neurosurgery 72:646–652, discussion 651–642
Molyneux A, Kerr R, Stratton I et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274
Wong GK, Boet R, Ng SC et al (2012) Ultra-early (within 24 hours) aneurysm treatment after subarachnoid hemorrhage. World Neurosurg 77:311–315
Guglielmi G, Vinuela F, Dion J et al (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75:8–14
Moret J, Cognard C, Weill A et al (1997) Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol 24:30–44
van Rooij WJ, Sluzewski M, Beute GN et al (2006) Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 27:1498–1501
Shapiro M, Babb J, Becske T et al (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29:1777–1781
Albayram S, Selcuk H, Kara B et al (2004) Thromboembolic events associated with balloon-assisted coil embolization: evaluation with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 25:1768–1777
Crowley RW, Albuquerque FC, Ducruet AF et al (2012) Technical considerations in the endovascular management of aneurysms of the posterior inferior cerebellar artery. Neurosurgery 71:ons204–ons217, discussion ons217–ons208
Chapot R, Houdart E, Saint-Maurice JP et al (2002) Endovascular treatment of cerebral mycotic aneurysms. Radiology 222:389–396
Yoo E, Kim DJ, Kim DI et al (2009) Bailout stent deployment during coil embolization of intracranial aneurysms. AJNR Am J Neuroradiol 30:1028–1034
Gonzalez AM, Narata AP, Yilmaz H et al (2014) Blood blister-like aneurysms: single center experience and systematic literature review. Eur J Radiol 83:197–205
Spetzler RF, McDougall CG, Albuquerque FC et al (2013) The barrow ruptured aneurysm trial: 3-year results. J Neurosurg 119:146–157
Cudlip SA, Kitchen ND, McKhahn GM et al (1998) Wrapping of solitary ruptured intracranial aneurysms, outcome at five years. Acta Neurochir 140:1167–1170, discussion 1170–1161
Kivipelto L, Niemela M, Meling T et al (2014) Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree. J Neurosurg 120:398–408
Valenca MM (2013) “Sit back, observe, and wait.” Or is there a pharmacologic preventive treatment for cerebral aneurysms? Neurosurg Rev 36:1–9, discussion 9–10
Edlow JA, Malek AM, Ogilvy CS (2008) Aneurysmal subarachnoid hemorrhage: update for emergency physicians. J Emerg Med 34:237–251
Rosengart AJ, Schultheiss KE, Tolentino J et al (2007) Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke J Cereb Circ 38:2315–2321
Feigin VL, Findlay M (2006) Advances in subarachnoid hemorrhage. Stroke J Cereb Circ 37:305–308
Koenig MA (2012) Management of delayed cerebral ischemia after subarachnoid hemorrhage. Continuum 18:579–597
Inagawa T, Kamiya K, Ogasawara H et al (1987) Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28:93–99
Ohkuma H, Tsurutani H, Suzuki S (2001) Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke J Cereb Circ 32:1176–1180
Hasan D, Lindsay KW, Vermeulen M (1991) Treatment of acute hydrocephalus after subarachnoid hemorrhage with serial lumbar puncture. Stroke J Cereb Circ 22:190–194
Dorsch NW (1995) Cerebral arterial spasm–a clinical review. Br J Neurosurg 9:403–412
Dumont AS, Dumont RJ, Chow MM et al (2003) Cerebral vasospasm after subarachnoid hemorrhage: putative role of inflammation. Neurosurgery 53:123–133, discussion 133–125
Sanchez-Pena P, Nouet A, Clarencon F et al (2012) Atorvastatin decreases computed tomography and S100-assessed brain ischemia after subarachnoid aneurysmal hemorrhage: a comparative study. Crit Care Med 40:594–602
Biondi A, Ricciardi GK, Puybasset L et al (2004) Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage: preliminary results. AJNR Am J Neuroradiol 25:1067–1076
Linfante I, Delgado-Mederos R, Andreone V et al (2008) Angiographic and hemodynamic effect of high concentration of intra-arterial nicardipine in cerebral vasospasm. Neurosurgery 63:1080–1086, discussion 1086–1087
Shankar JJ, dos Santos MP, Deus-Silva L et al (2011) Angiographic evaluation of the effect of intra-arterial milrinone therapy in patients with vasospasm from aneurysmal subarachnoid hemorrhage. Neuroradiology 53:123–128
Dorsch NW (2002) Therapeutic approaches to vasospasm in subarachnoid hemorrhage. Curr Opin Crit Care 8:128–133
Hart Y, Sneade M, Birks J et al (2011) Epilepsy after subarachnoid hemorrhage: the frequency of seizures after clip occlusion or coil embolization of a ruptured cerebral aneurysm: results from the International Subarachnoid Aneurysm Trial. J Neurosurg 115:1159–1168
Claassen J, Peery S, Kreiter KT et al (2003) Predictors and clinical impact of epilepsy after subarachnoid hemorrhage. Neurology 60:208–214
Ahmadian A, Mizzi A, Banasiak M et al (2013) Cardiac manifestations of subarachnoid hemorrhage. Heart Lung Vessels 5:168–178
Proust F, Martinaud O, Gerardin E et al (2009) Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. J Neurosurg 110:19–29
Terson A (1900) De l’hémorrhagie dans le corps vitre au cours de l’hémorrhagie cerebrale. Clin Ophthalmol 6:309–312
Stienen MN, Lucke S, Gautschi OP et al (2012) Terson haemorrhage in patients suffering aneurysmal subarachnoid haemorrhage: a prospective analysis of 60 consecutive patients. Clin Neurol Neurosurg 114:535–538
Chen M (2013) A checklist for cerebral aneurysm embolization complications. J Neurointerv Surg 5:20–27
Ricolfi F, Le Guerinel C, Blustajn J et al (1998) Rupture during treatment of recently ruptured aneurysms with Guglielmi electrodetachable coils. AJNR Am J Neuroradiol 19:1653–1658
Elijovich L, Higashida RT, Lawton MT et al (2008) Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke J Cereb Circ 39:1501–1506
Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482
Cognard C, Weill A, Castaings L et al (1998) Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:499–510
Doerfler A, Wanke I, Egelhof T et al (2001) Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome. AJNR Am J Neuroradiol 22:1825–1832
Ryu CW, Lee CY, Koh JS et al (2011) Vascular perforation during coil embolization of an intracranial aneurysm: the incidence, mechanism, and clinical outcome. Neurointervention 6:17–22
Cloft HJ, Kallmes DF (2002) Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. AJNR Am J Neuroradiol 23:1706–1709
Leipzig TJ, Morgan J, Horner TG et al (2005) Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms. Neurosurgery 56:455–468, discussion 455–468
Brooks NP, Turk AS, Niemann DB et al (2008) Frequency of thromboembolic events associated with endovascular aneurysm treatment: retrospective case series. J Neurosurg 108:1095–1100
Altay T, Kang HI, Woo HH et al (2011) Thromboembolic events associated with endovascular treatment of cerebral aneurysms. J Neurointerv Surg 3:147–150
Aggour M, Pierot L, Kadziolka K et al (2010) Abciximab treatment modalities for thromboembolic events related to aneurysm coiling. Neurosurgery 67:503–508
Fourie P, Duncan IC (2003) Microsnare-assisted mechanical removal of intraprocedural distal middle cerebral arterial thromboembolism. AJNR Am J Neuroradiol 24:630–632
Krayenbuhl N, Erdem E, Oinas M et al (2009) Symptomatic and silent ischemia associated with microsurgical clipping of intracranial aneurysms: evaluation with diffusion-weighted MRI. Stroke J Cereb Circ 40:129–133
Wang T, Zhang JH, Qin X (2011) Analysis on death-associated factors of patients with subarachnoid hemorrhage during hospitalization. Acta Neurochir Suppl 110:219–223
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9
Iosif C, Di Maria F, Sourour N et al (2013) Is a high initial World Federation of Neurosurgery (WFNS) grade really associated with a poor clinical outcome in elderly patients with ruptured intracranial aneurysms treated with coiling? J Neurointerv Surg
Degos V, Gourraud PA, Tursis VT et al (2012) Elderly age as a prognostic marker of 1-year poor outcome for subarachnoid hemorrhage patients through its interaction with admission hydrocephalus. Anesthesiology 117:1289–1299
Degos V, Apfel CC, Sanchez P et al (2012) An admission bioclinical score to predict 1-year outcomes in patients undergoing aneurysm coiling. Stroke J Cereb Circ 43:1253–1259
Raymond J, Molyneux AJ, Fox AJ et al (2008) The TEAM trial: safety and efficacy of endovascular treatment of unruptured intracranial aneurysms in the prevention of aneurysmal hemorrhages: a randomized comparison with indefinite deferral of treatment in 2002 patients followed for 10 years. Trials 9:43
Lall RR, Eddleman CS, Bendok BR et al (2009) Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data. Neurosurg Focus 26:E2
Cebral JR, Mut F, Weir J et al (2011) Quantitative characterization of the hemodynamic environment in ruptured and unruptured brain aneurysms. AJNR Am J Neuroradiol 32:145–151
Cebral JR, Sheridan M, Putman CM (2010) Hemodynamics and bleb formation in intracranial aneurysms. AJNR Am J Neuroradiol 31:304–310
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Science+Business Media New York
About this entry
Cite this entry
Clarençon, F. et al. (2016). Aneurysmal Subarachnoid Hemorrhage. In: Saba, L., Raz, E. (eds) Neurovascular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9029-6_19
Download citation
DOI: https://doi.org/10.1007/978-1-4614-9029-6_19
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-9028-9
Online ISBN: 978-1-4614-9029-6
eBook Packages: MedicineReference Module Medicine