Microsurgical treatment of vascular disease. Part II. Intracranial aneurysms, intracranial and intraspinal arteriovenous malformations.
Explore the source record for details and available documents.
Adult↗
SEARCH · Search PubMed
Results for “Intracranial Aneurysm”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Evidence in favor of the contribution of genes involved in the maintenance of the extracellular matrix of the arterial wall to the development of intracranial aneurysms.
Intracranial aneurysm is probably a complex disease with both genetic and non-genetic or environmental risk factors contributing to the etiology of the disease. A disruption of the extracellular matrix (ECM) of the arterial wall is a likely factor in the pathogenesis of intracranial aneurysms. We analyzed 44 potential candidate genes involved in the maintenance of the integrity of the ECM in 382 Dutch Caucasian patients with intracranial aneurysms and 609 Dutch Caucasian controls for 384 tag single nucleotide polymorphisms (SNPs) using the GoldenGate assay on an Illumina BeadStation 500 GX. We identified SNPs that were associated with intracranial aneurysms (P<0.01) in six of these 44 genes: serpine1 (SERPINE1, P=0.0008), transforming growth factor beta induced (TGFBI, P=0.0026), perlecan (HSPG2, P=0.0044), fibronectin (FN1, P=0.0069), fibrillin 2 (FBN2, P=0.0077) and alpha 1 type IV collagen (COL4A1, P=0.0087). In a second independent cohort of 310 Dutch Caucasian intracranial aneurysm patients and 336 Dutch Caucasian controls, the association for the HSPG2 gene [combined odds ratio (OR) 1.33, 95% confidence interval (CI) 1.13-1.57, P=6 x 10(-4)] was replicated. The population attributable risk (PAR) for this SNP is 19%. Combining the two cohorts still showed association for the SERPINE1 (combined OR 1.27, 95% CI 1.07-1.50, P=0.004, PAR 6%), FBN2 (combined OR 1.37, 95% CI 1.07-1.75, P=0.01, PAR 3%) and COL4A1 (combined OR 1.22, 95% CI 1.05-1.42, P=0.007, PAR 7%) genes. These PARs are likely to be overestimates as they are calculated from the joint analyses combining stages 1 and 2 of our association study. Our findings indicate that variation in genes involved in the maintenance of the integrity of the ECM of the arterial wall plays a role in susceptibility to intracranial aneurysms. These findings further support our hypothesis that diminished maintenance of the ECM of the arterial wall is important in the development of intracranial aneurysms.
Extracellular Matrix↗
Familial occurrence of intracranial aneurysms.
Intracranial aneurysms occurring in three families are reported. As a result of the discovery of splenic artery aneurysms in one of the family members the relation between intracranial aneurysms and aneurysms in other sites is discussed. It is put forward that aneurysms might be a part of a generalized connective tissue disease, and the relation between aneurysms and some connective tissue diseases is stressed. At present extensive angiographic investigations in family cases cannot be recommended in every family.
Adult↗
Iatrogenic intracranial aneurysms.
Intracranial aneurysms following head trauma are not uncommon. Few cases of iatrogenic intracranial aneurysm have been reported however. This type of lesion is illustrated by three cases. If these lesions have the same poor prognosis as that proposed for the usual traumatic aneurysm, their early diagnosis and treatment is important.
Adult↗
Management of intracranial aneurysms.
Intracranial aneurysms are lesions commonly encountered by neurosurgeons, usually as a result of subarachnoid hemorrhage. The preferred treatment of these aneurysms is either surgical clipping or endovascular coiling, both of which eliminate the aneurysm from the normal circulation to prevent aneurysmal enlargement or additional hemorrhage. Despite advances over the last several decades in the understanding of intracranial aneurysms, morbidity from treatment of these lesions remains significant. This review will discuss the epidemiology, anatomy and pathophysiology, clinical and radiographic diagnosis, various treatment options, and potential complications from aneurysm treatment.
Embolization, Therapeutic↗
Magnetic resonance imaging of intracranial aneurysms.
Intracranial aneurysms are lesions with high morbidity and mortality, but in most cases represent treatable disease. Magnetic resonance (MR) imaging and in some cases MR angiography can make valuable contributions to their diagnosis and characterization. The ultimate tool for imaging these lesions, however, remains catheter angiography. This article focuses on saccular aneurysms, with a brief discussion on atherosclerotic fusiform aneurysms and mycotic aneurysms.
Aneurysm, Infected↗
Complete asymptomatic thrombosis and resorption of a congenital giant intracranial aneurysm.
Intracranial aneurysms in infants are rare, but are associated with a high risk of rupture and subarachnoid hemorrhage. The authors report a case of an incidentally diagnosed, probably congenital, asymptomatic giant aneurysm of the posterior communicating artery in a 9-month-old girl, which completely thrombosed following a diagnostic superselective angiography without any neuropathological incident. Follow-up magnetic resonance imaging revealed that the aneurysm decreased further in size and was largely resorbed within 3 years after the initial finding. In single cases the natural history of congenital giant aneurysms may be better than previously assumed.
Cerebral Angiography↗
Intracranial pressure in patients with diffuse cerebral arterial spasm following ruptured intracranial aneurysms.
Intracranial pressure (ICP) was recorded continuously in 12 pre-operative patients with angiographic evidence of diffuse cerebral arterial spasm due to a ruptured intracranial aneurysm. Recordings were made for 1 to 7 days, starting within 13 days after the haemorrhage. 1. An increased ICP was observed in the first week after subarachnoid haemorrhage (SAH) in 4 of the patients without any signs of angiographic arterial spasm. 2. This initial increase was regularly followed by a depression of ICP in between 7--12 days after SAH. In 11 out of 12 patients such a depression was concomitant with the beginning of arterial spasm. During the period of depressed ICP pattern, 6 patients showed little or no neurological deterioration, whereas 5 patients showed impaired consciousness or neurological deficits. 3. A secondary rise of ICP thereafter always followed due to ischaemic brain swelling or infarction, and was usually associated with a serious neurological deterioration. 4. Continuous ventricular drainage was performed to control the secondary increased ICP in 7 patients who survived, 4 of them with good clinical improvement and 3 with severe neurological deficits. 5. In the stage of depressed ICP, the administration of isoproterenol and steroids is recommended in order to try to alleviate the secondary rise of ICP.
Acute Disease↗
ICP patterns and isotope cisternography in patients with communicating hydrocephalus following rupture of intracranial aneurysm.
Intracranial pressure (ICP) was continuously recorded, isotope cisternography was performed, and the ventricular system size was evaluated on serial computerized tomography scans in 39 patients. All of these patients had communicating hydrocephalus after subarachnoid hemorrhage (SAH) from rupture of an intracranial aneurysm. The studies were carried out in both the acute stage (within 7 days after SAH) and the communicating hydrocephalus stage. In patients in the acute stage who had no ventricular dilatation, but who later developed communicating hydrocephalus, the resting ICP was high, and an ICP pattern of B-wave activity was seen; there was no delay in cerebrospinal fluid (CSF) absorption on isotope cisternography. Patients with communicating hydrocephalus in whom ICP recordings were started within 63 days after SAH had a pattern of plateau waves in conjunction with B-waves, and there was a marked delay in CSF circulation. In general, patients with higher resting ICP's had more frequent ICP irregularities. Patients with communicating hydrocephalus in whom recordings were begun more than 6 months after SAH had a low and flat ICP pattern, and there was no delay in CSF absorption in spite of bilateral convexity blocks on isotope cisternography. The results suggest that the ICP pattern of plateau waves in conjunction with B-waves can be regarded as a sign of delayed CSF absorption; hence, shunting procedures may be indicated in patients with plateau waves in conjunction with B-waves visualized on continuous ICP recordings.
Adult↗
Multi-Omics Genome-Wide to Explore the Formation and Development Targets for Intracranial Aneurysms.
Intracranial aneurysms (IAs) represent a significant and potentially life-threatening category of disease, and there is currently a lack of effective treatment options aimed at preventing the progression of the disease. Accordingly, this study is dedicated to exploring and identifying effective drug targets that can help in the prevention of both the formation and rupture of IAs, along with a detailed examination of the underlying potential mechanisms involved in these processes. The data related to IAs for this research was obtained from the ISGC Biobank and UK Biobank. Then, we investigated the possible biological functions and unintended consequences of targeting the specific genes that were highlighted in IAs by using mediation analysis, virtual knockout experiments, and PW-MR studies. A total of 5 unique potential drug targets for IAs (FKTN, MAP3K1, PSMA4, SLC22A4, ADAM17), 4 unique potential drug targets for SAH (PSMA4, ADAM17, GPR160, SLC22A4), and 2 unique potential drug targets for UIA (SLC22A4, PRCP) were identified across brain or blood samples. Among the various candidates identified, SLC22A4 has emerged as a promising potential drug target, showing significant expression levels in both blood and brain tissues. Additionally, phenome-wide MR of SLC22A4 across 32 selected phenotypes did not identify statistically significant adverse associations after FDR correction. Virtual knockout (KO) experiments on SLC22A4 revealed that SLC22A4 KO disrupted 81 genes, all of which are involved in IAs-related pathways. Besides, we recognized BRD-K85337334 as potential candidates for targeting SLC22A4. This research indicates that an increase in SLC22A4 gene expression within the blood or brain is directly linked to a heightened risk of IAs rupture, which will aid in prioritizing the development of drugs for IAs.
Humans↗
Neuroendovascular management of intracranial aneurysms.
Intracranial aneurysms are a common disease constituting a significant health problem worldwide. Aneurysmal subarachnoid hemorrhage, cerebral aneurysms, classification of aneurysms, and management of aneurysms are discussed.
Cerebrovascular Circulation↗
[Ion-beam irradiated ePTFE for the therapy of intracranial aneurysms].
Intracranial aneurysms are frequently treated with either microsurgical clipping or endovascular coiling. However, as so called broad-neck aneurysms are not suitable for these treatment options, a wrapping technique using muslin gauze, muscle piece, ePTFE is applied for such cases. The material for aneurysmal wrapping demands both stable adherence and no reactive inflammatory response such as inert artificial wall. Authors have developed a new improved ePTFE by ion-beam irradiation technique that is biologically inert and able to adhere firmly to surrounding tissue. Based on the last studies, Ar+ ion at an energy of 150 keV with a fluence of 5 x 10(14) ions/cm2 was chosen to irradiate ePTFE. A cell adhesion test and direct implantation of ion-beam irradiated ePTFE as wrapping material to rabbit common carotid arteries (CCA) were examined. It was demonstrated that the surface of ion-beam irradiated ePTFE exhibits remarkably greater adhesion and promotes cell proliferation on the surface more effectively than that of non-irradiated ePTFE. The carotid artery well-wrapped by ion-beam irradiated ePTFE strongly adhered to the mural wall and induced little inflammatory reaction. The results of this investigation indicate that application of this technology would offer the best means for aneurysm wrapping.
Animals↗
Surgical treatment of intracranial aneurysms.
Intracranial aneurysms are dangerous lesions which may produce sudden death or neurological devastation in people who are often otherwise completely healthy. The definitive treatment for most of these lesions in microsurgical repair, and the cure rate is quite high. The indications for surgery include an accessible aneurysm in a patient who is healthy enough to tolerate general anesthesia and a major intracranial procedure. The timing of surgery following subarachnoid hemorrhage is still controversial, but early surgery is currently recommended for patients who are alert. Preoperative imaging studies are crucial in defining the precise anatomy of the aneurysm and any associated lesions and anomalies. Surgical approaches and techniques, anesthetic considerations, postoperative radiographic evaluation, overall results, and complications are discussed in this article.
Anesthesia, General↗
Magnetic resonance imaging of intracranial aneurysms
Intracranial aneurysms are lesions with high morbidity and mortality, but in most cases represent treatable disease. Magnetic Resonance (MR) imaging and in some cases MR angiography can make valuable contributions to their diagnosis and characterization. The ultimate tool for imaging these lesions, however, remains catheter angiography. This article focuses on saccular aneurysms, with a brief discussion on atherosclerotic fusiform aneurysms and mycotic aneurysms.
Journal Article↗
Co-existence of abdominal aortic aneurysms and intracranial aneurysms.
The occurrence of abdominal aortic aneurysms (AAAs) and intracranial aneurysms (IAs) in the same patient and in the same family was studied among 89 patients with AAAs and 485 patients with IAs. Among the AAA-patients two had IAs themselves and five had IAs in the family, whereas three IA-patients had AAAs themselves and eight had AAAs in the family. Moreover, one of the patients with both AAA and IA had a blood relative with AAA, and in six of the families with both types of aneurysms there were more than two subjects with aneurysms. The results indicate, that AAAs and IAs may have a common aetiologic factor.
Adult↗
Stereological analysis of the layered collagen of human intracranial aneurysms.
Intracranial saccular aneurysms are balloon-like distensions of the arterial wall; they increase in size gradually, a few to the point of bleeding or catastrophic rupture. Collagen is the primary structural component of the aneurysmal wall, and because only a small fraction of aneurysms fail, the collagen fabric must effectively reorganize in order to maintain mechanical integrity as an aneurysm changes size. Data were obtained from four human aneurysms, fixed at 110 mmHG of distending pressure with 10% buffered formalin, and sectioned completely through at 4 microns thickness. Each set of measurements included groups of data taken layer by layer from a radial corridor across the aneurysm wall. Each three-dimensional orientation measurement, for which we used a Zeiss polarizing microscope with a universal stage attachment, is defined by an azimuth and elevation angle relative to the section plane. We compared the interdependence of these measured angles with a mathematical model based on fibres following great circle trajectories, and related the measured azimuth and elevation angles to the relative depth of the section into the aneurysm. Data were plotted on Lambert equal-area projections, along with the theoretical relation between azimuth and elevation, that included wall thickness and depth of sectioning. The graphical relationship between measured azimuth and elevation for collagen fibres across the layered fabric of the aneurysmal wall is consistent with the theoretical great circle trajectories for collagen fibre alignment. Analysis was based on statistics for spherical data to give values for the mean orientation and the circular standard deviations (CSD) about that mean. The results indicate that any given region on the aneurysm wall is made up of many, very thin sublayers, most of which have a relatively coherent organization (mean CSD 8 degrees). These measurements agree well with the mathematical model and, when considered collectively, the layers provide a balanced distribution for bearing the biaxial tensile stress of the wall.
Adult↗
Cerebral vasospasm in patients with unruptured intracranial aneurysms.
Intracranial arterial vasospasm is a typical sequela of subarachnoid haemorrhage. The association between symptomatic vasospasm and unruptured aneurysms has been sporadically presented in the literature. The pathogenesis of this unusual entity is unclear. The published cases were collected in this review and analysed with regard to timing, clinical presentation and possible relationship with surgical factors. We also added an illustrative case which was recently observed in our department.
Cerebral Angiography↗
[Behcet's disease manifested as a intracranial aneurysm].
INTRODUCTION: Mostly venous (95% of all vascular complications), and less frequently arterial (2 to 7% of all cases), vascular complications are commonplace in Behçet's disease (23 to 64% of the patients, depending on the series). Arterial complications are stenosis, occlusions and especially severe due to their unpredictable rupture risk, aneurysms. Intracranial aneurysms associated with Behçet's disease are exceptional. Until now, only ten cases have been published. EXEGESIS: We report the case of a 36-year-old patient of Armenian origin in whom the diagnosis of Behçet's disease was made after a subarachnoid hemorrhage caused by the rupture of a left superior cerebellar artery aneurysm. The endovascular treatment of the aneurysm was associated with an immunosuppressive treatment consisting of cyclophosphamide, corticoids and colchicine. Within a 6-month period of follow up the evolution has been favorable. This is the first published case report of Behçet's disease associated with an aneurysm of the posterior circulation treated endovascularly. A review of the literature is also included. CONCLUSION: Intracranial aneurysms are an exceptional but nevertheless severe localization of vascular complications in Behçet's disease. As in all other arterial lesions, recurrences are frequent. The treatment involves surgical or endovascular treatment that should be associated with corticoids and immunosuppressive therapy. Colchicine is useful for the prevention of relapses.
Adult↗