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Intracranial Aneurysms: Treatment and Complications
Research Guide
What is Intracranial Aneurysms: Treatment and Complications?
Intracranial Aneurysms: Treatment and Complications refers to the medical management of cerebral aneurysms through methods such as neurosurgical clipping and endovascular coiling, along with associated risks including aneurysmal subarachnoid hemorrhage, cerebral vasospasm, and delayed cerebral ischemia.
The field encompasses over 85,000 published works on the pathophysiology, natural history, diagnosis, and treatment outcomes of intracranial aneurysms. Key treatments include neurosurgical clipping and endovascular coiling, as compared in randomized trials like the International Subarachnoid Aneurysm Trial (ISAT). Complications such as cerebral vasospasm relate directly to the amount and distribution of subarachnoid blood visualized by CT scanning.
Topic Hierarchy
Research Sub-Topics
Aneurysmal Subarachnoid Hemorrhage
This sub-topic covers the acute pathophysiology, early brain injury, and systemic complications following aneurysm rupture leading to subarachnoid hemorrhage. Researchers study biomarkers, neuroprotective strategies, and prediction of poor outcomes.
Endovascular Treatment of Intracranial Aneurysms
This sub-topic focuses on coiling, flow diversion, and stent-assisted techniques for treating ruptured and unruptured aneurysms via catheter-based approaches. Researchers compare long-term occlusion rates, recurrence, and procedural safety against clipping.
Cerebral Vasospasm After SAH
This sub-topic investigates the mechanisms, diagnosis via transcranial Doppler, and pharmacological prevention (nimodipine) of arterial narrowing causing ischemia post-SAH. Researchers explore biomarkers, endovascular rescue, and genetic risk factors.
Delayed Cerebral Ischemia
This sub-topic addresses multifactorial delayed cerebral ischemia beyond vasospasm, including microthrombosis, cortical spreading depression, and inflammation after SAH. Researchers develop multimodal monitoring and neuroprotective interventions.
Computational Hemodynamics of Intracranial Aneurysms
This sub-topic uses CFD modeling to study wall shear stress, particle trajectories, and inflow dynamics predicting aneurysm growth and rupture risk. Researchers validate models with 4D flow MRI and patient-specific geometries.
Why It Matters
Treatment of intracranial aneurysms prevents rupture leading to subarachnoid hemorrhage, a major cause of stroke and death, with guidelines providing evidence-based recommendations for diagnosis and management. The ISAT trial involving 2143 patients with ruptured aneurysms showed endovascular coiling resulted in better clinical outcomes at one year compared to neurosurgical clipping (Molyneux, 2002). Unruptured intracranial aneurysms carry risks from surgical and endovascular interventions that must be weighed against natural history progression (Wiebers, 2003). Guidelines for aneurysmal subarachnoid hemorrhage synthesize data to reduce mortality, with formal literature searches informing recommendations on securing the aneurysm and preventing vasospasm (Connolly et al., 2012). Cerebral vasospasm incidence increases with concentrated subarachnoid blood on CT, affecting prognosis in 47 verified ruptured aneurysm cases (Fisher et al., 1980).
Reading Guide
Where to Start
"Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage" (Connolly et al., 2012) provides a comprehensive synthesis of diagnosis and treatment recommendations, serving as an ideal starting point for understanding current standards.
Key Papers Explained
"Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment" (Wiebers, 2003) establishes baseline risks, which the "International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms" (Molyneux, 2002) builds on by providing randomized evidence for ruptured cases. "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage" (Connolly et al., 2012) integrates these with literature up to 2010. "Relation of Cerebral Vasospasm to Subarachnoid Hemorrhage Visualized by Computerized Tomographic Scanning" (Fisher et al., 1980) details a key complication mechanism, while "Surgical Risk as Related to Time of Intervention in the Repair of Intracranial Aneurysms" (Hunt and Hess, 1968) addresses timing.
Paper Timeline
Most-cited paper highlighted in red. Papers ordered chronologically.
Advanced Directions
Recent literature emphasizes endovascular techniques and vasospasm prevention, though no preprints or news from the last 12 months are available. Frontiers include refining risk stratification for unruptured aneurysms and optimizing post-coiling management based on ISAT extensions.
Papers at a Glance
| # | Paper | Year | Venue | Citations | Open Access |
|---|---|---|---|---|---|
| 1 | Frontotemporal lobar degeneration | 1998 | Neurology | 5.0K | ✕ |
| 2 | Family history of subarachnoid haemorrhage: supplemental value... | 1997 | Journal of Neurology N... | 4.1K | ✓ |
| 3 | Unruptured intracranial aneurysms: natural history, clinical o... | 2003 | The Lancet | 3.8K | ✕ |
| 4 | International Subarachnoid Aneurysm Trial (ISAT) of neurosurgi... | 2002 | The Lancet | 3.6K | ✕ |
| 5 | Guidelines for the Management of Aneurysmal Subarachnoid Hemor... | 2012 | Stroke | 3.4K | ✓ |
| 6 | Surgical Risk as Related to Time of Intervention in the Repair... | 1968 | Journal of neurosurgery | 3.4K | ✕ |
| 7 | Classification and natural history of clinically identifiable ... | 1991 | The Lancet | 3.3K | ✕ |
| 8 | MRC European Carotid Surgery Trial: interim results for sympto... | 1991 | The Lancet | 3.3K | ✕ |
| 9 | Relation of Cerebral Vasospasm to Subarachnoid Hemorrhage Visu... | 1980 | Neurosurgery | 3.1K | ✕ |
| 10 | Stenting versus Endarterectomy for Treatment of Carotid-Artery... | 2010 | New England Journal of... | 2.9K | ✓ |
Frequently Asked Questions
What are the main treatments for ruptured intracranial aneurysms?
Neurosurgical clipping and endovascular coiling are primary treatments. The International Subarachnoid Aneurysm Trial (ISAT) compared these in 2143 patients, finding coiling superior for one-year outcomes. Guidelines recommend securing the aneurysm promptly to prevent rebleeding.
How does subarachnoid blood distribution affect cerebral vasospasm?
Cerebral vasospasm develops more frequently with concentrated subarachnoid blood on CT scans. In 47 cases of ruptured saccular aneurysms, diffuse or undetectable blood correlated with low vasospasm rates. Fisher et al. (1980) established this relation through computerized tomographic findings.
What do guidelines recommend for aneurysmal subarachnoid hemorrhage management?
Guidelines synthesize literature from 2006-2010 for diagnosis, treatment, and complication prevention. They cover aneurysm securing, vasospasm management, and hydrocephalus treatment. Connolly et al. (2012) provide comprehensive recommendations based on MEDLINE searches.
What risks are associated with treating unruptured intracranial aneurysms?
Surgical and endovascular treatments carry procedural risks weighed against natural history. Wiebers (2003) reported clinical outcomes and risks in unruptured cases. Patient-specific factors determine intervention benefits.
Why is family history important in subarachnoid hemorrhage risk assessment?
Bedside family history has modest accuracy for screening relatives. Greebe et al. (1997) found thorough data collection from all relatives adds value. This informs decisions on screening for unruptured aneurysms.
What is the role of timing in intracranial aneurysm repair?
Surgical risk relates to intervention timing post-rupture. Hunt and Hess (1968) analyzed outcomes based on time from hemorrhage. Early intervention balances rebleeding risk against complication rates.
Open Research Questions
- ? How can imaging better predict vasospasm risk beyond subarachnoid blood distribution?
- ? What factors explain better long-term outcomes in coiling versus clipping beyond ISAT results?
- ? How do patient-specific hemodynamics influence treatment selection for unruptured aneurysms?
- ? What interventions most effectively prevent delayed cerebral ischemia after subarachnoid hemorrhage?
- ? How accurate are family history assessments for identifying screening candidates across generations?
Recent Trends
The field includes 85,159 works with no specified 5-year growth rate.
Landmark trials like ISAT (Molyneux, 2002) and guidelines (Connolly et al., 2012) continue to shape endovascular preference over clipping.
No recent preprints or news coverage reported in the last 12 months.
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