In a nutshell
This paper reviewed the management of intracranial aneurysms.
Some background
An intracranial aneurysm, or brain aneurysm, is a weakness in the wall of a blood vessel in the brain. Because the blood vessel wall is weak, the aneurysm can rupture and bleed into the brain. Brain saccular aneurysms (type of intracranial aneurysm) are increasingly being detected. However, there is still controversy regarding the treatment of small brain aneurysms that have not ruptured.
Methods & findings
Unruptured brain aneurysms are more common in women and elderly people. Certain genetic factors are associated with risk of brain aneurysms. Cigarette smoking and high blood pressure are also associated with brain aneurysms.
Management of brain aneurysms requires consideration of various factors.
Studies show that the risk of an aneurysm rupture increases with age and size of the aneurysm. Findings from several studies have suggested that rupture risk is reduced in patients taking aspirin.
Surgical treatment using craniotomy (part of skull removed to expose brain) and clipping of an unruptured brain aneurysm is effective. This prevents blood from entering the aneurysm and the aneurysm will decrease in size. In a large study, mortality following surgery was 2.6% and morbidity (unhealthy state) was 10.9%.
Endovascular options, which are minimally invasive procedures where the aneurysm is reached through the bloodstream, are also available. The Guglielmi detachable coil system is most common, where soft wire coils are inserted into the aneurysm. These coils cause blood clots and scar tissue to form, protecting the aneurysm from rupture. In one study, the combined morbidity and mortality of patients treated with an endovascular procedure was 9.5% at 1 year. A large aneurysm size was associated with worse outcome.
Interventional treatment (surgeries or procedures) should probably be done for large unruptured brain aneurysms. For elderly patients, a conservative approach is recommended as risks increases with age. For patients over the age of about 60 years, conservative management is usually recommended for small aneurysms.
The bottom line
The authors concluded that the optimum management strategy for unruptured brain aneurysms remains unclear.
What’s next?
Talk to your doctor about potential risk factors for aneurysm ruptures as well as treatment options.
Published By :
The Lancet neurology
Date :
Apr 01, 2014
