62 Incidental Aneurysms

In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical clipping vs. endovascular coiling in concern to post-procedural headaches in patients with ruptured aneurysms. Sixtyseven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1st 2015 - September 1st 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or highgrade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated. We compared the post-procedural headaches at the time points of 24 h, 21 days, and 3 months after treatment using the visual analog scale (VAS) for pain. After surgical clipping the headache score decreased for 8.8 points in the VAS, whereas the endovascular treated population showed a decrease of headaches of 3.3 points. This difference was highly statistical significant and remained significant even after 3 weeks where the pain score for the surgically treated patients was 0.68 and for the endovascular treated 1.8. After 3 months the pain was less than 1 for both groups with surgically treated patients scoring 0.1 and endovascular treated patients 0.9 (not significant). Clipping is relieving the headaches of patients with aneurysm rupture faster and more effective than endovascular coiling. This effect stays significant for at least 3 weeks and plays a crucial role in stress relieve during the acute and subacute ICU care of such patients.

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Perianeurysmal edema as a predictive sign of aneurysmal rupture

Journal of Neurosurgery ◽

10.3171/2014.6.jns132558 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1112-1114 ◽

Cited By ~ 6

Author(s):

Felix Hendrik Pahl ◽

Matheus Fernandes de Oliveira ◽

Nelson Paes Fortes Diniz Ferreira ◽

Leonardo Lopes de Macedo ◽

Roger Schmidt Brock ◽

...

Keyword(s):

Resonance Imaging ◽

Mri Findings ◽

Intraluminal Thrombus ◽

Aneurysmal Rupture ◽

Aneurysm Wall ◽

Incidental Aneurysms ◽

Bleb Formation ◽

Few Data ◽

Clear Increase

Subarachnoid hemorrhage following intracranial aneurysmal rupture is a major cause of morbidity and mortality. Several factors may affect the probability of rupture, such as tobacco and alcohol use; size, shape, and location of the aneurysm; presence of intraluminal thrombus; and even the sex of the patient. However, few data correlate such findings with the timing of aneurysmal rupture. The authors report 2 cases of middle-age women with headache and MRI findings of incidental aneurysms. Magnetic resonance imaging showed evidence of surrounding parenchymal edema, and in one case there was a clear increase in edema during follow-up, suggesting a progressive inflammatory process that culminated with rupture. These findings raise the possibility that bleb formation and an enlargement of a cerebral aneurysm might be associated with an inflammatory reaction of the aneurysm wall resulting in perianeurysmal edema and subsequent aneurysmal rupture. There may be a temporal link between higher degree of edema and higher risk for rupture, including risk for immediate rupture.

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Incidental aneurysms

The Neurosurgeon's Handbook ◽

10.1093/med/9780198570677.003.0446 ◽

2010 ◽

pp. 569-572

Author(s):

George Samandouras

Keyword(s):

Incidental Aneurysms

Chapter 9.8 covers incidental aneurysms, including whether to treat and aneurysm screening.

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A Case of Acute Vertigo with Incidental Aneurysms

Neurosurgery ◽

10.1097/00006123-199504000-00025 ◽

1995 ◽

Vol 36 (4) ◽

pp. 827???833 ◽

Cited By ~ 1

Author(s):

H. Hunt Batjer ◽

Philip E. Stieg ◽

Richard B. Schwartz

Keyword(s):

Incidental Aneurysms

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Treatment of Cerebral Aneurysms: Surgical, Endovascular or Combined Intervention

Interventional Neuroradiology ◽

10.1177/15910199980040s132 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 153-158 ◽

Cited By ~ 1

Author(s):

H. Sano ◽

Y. Kato ◽

F.B. Singh ◽

N. Kanaoka ◽

K. Shankar ◽

...

Keyword(s):

Retrospective Study ◽

Treatment Group ◽

Intervention Group ◽

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Good Recovery ◽

Surgical Clipping ◽

Ruptured Aneurysms ◽

Incidental Aneurysms ◽

Combined Intervention

A retrospective study of 437 cases of cerebral aneurysms over a 4 year period is reported. Surgical clipping was performed in 322 cases (254 ruptured and 68 incidental aneurysms) and endovascular embolization was done in 50 cases (26 ruptured and 24 incidental aneurysms). No intervention (either surgical or endovascular) was performed in 65 patients. In the direct surgical treatment group, mortality was 1.5% in incidental and 9.8% in ruptured aneurysms and good recovery was seen in 98.5% and 74.8% cases respectively. In the endovascular intervention group, results were poor due to the severity of their neurological grading and older age. Mortality was 42.3% in ruptured and 4.2% in incidental aneurysms. Six out of 26 ruptured and 11 out 24 incidental aneurysm patients had complications in the endovascular treatment group. We have discussed the results and indications for both modes of treatment in our study.

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Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms

Journal of Neurosurgery ◽

10.3171/jns.2002.96.1.0043 ◽

2002 ◽

Vol 96 (1) ◽

pp. 43-49 ◽

Cited By ~ 139

Author(s):

H. Richard Winn ◽

John A. Jane ◽

James Taylor ◽

Donald Kaiser ◽

Gavin W. Britz

Keyword(s):

Prevalence Rate ◽

Cerebral Aneurysms ◽

Anterior Circulation ◽

Content Type ◽

Unruptured Aneurysms ◽

Incidental Aneurysms ◽

Unruptured Cerebral Aneurysms ◽

The University ◽

Yearly Rate ◽

Fine Print

Object. The prevalence of unruptured cerebral aneurysms is unknown, but is estimated to be as high as 5%. The goal of this study was to determine the prevalence of asymptomatic incidental aneurysms. Methods. The authors studied all cerebral arteriography reports produced at a single institution, the University of Virginia, between April 1969 and January 1980. A review of 3684 arteriograms demonstrated 24 cases of asymptomatic aneurysms, yielding a prevalence rate of 0.65%. The majority (67%) of the 24 patients harboring unruptured aneurysms were women. More than 90% of the unruptured aneurysms were located in the anterior circulation and in locations similar to those found in patients with ruptured aneurysms. Nearly 80% of the aneurysms were smaller than 1 cm in their greatest diameter. The frequency of asymmetrical unruptured aneurysms (0.6–1.5%) was constant throughout all relevant age ranges (35–84 years). Conclusions. While keeping in mind appropriate caveats in extrapolating from these data, the prevalence rate of asymptomatic unruptured aneurysms found in the present study allows an estimation of the yearly rate of rupture of these lesions. The authors suggest that this yearly rate of rupture falls within the range of 1 to 2%.

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Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system

Journal of Neurosurgery ◽

10.3171/jns.1999.90.2.0207 ◽

1999 ◽

Vol 90 (2) ◽

pp. 207-214 ◽

Cited By ~ 175

Author(s):

Yuichi Murayama ◽

Fernando Viñuela ◽

Gary R. Duckwiler ◽

Y. Pierre Gobin ◽

Guido Guglielmi

Keyword(s):

Intracranial Aneurysms ◽

Average Length ◽

Chronic Phase ◽

Hospital Length Of Stay ◽

Morbidity Rate ◽

Detachable Coil ◽

Content Type ◽

Guglielmi Detachable Coil ◽

Incidental Aneurysms ◽

Fine Print

Object. Guglielmi detachable coil (GDC) technology is a valuable therapeutic alternative to the surgical treatment of ruptured or incidental intracranial aneurysms. The authors describe their technical and clinical experience in the use of the GDC technique in patients who underwent endovascular occlusion for the treatment of incidentally found intracranial aneurysms.Methods. One hundred fifteen patients with 120 incidentally found intracranial aneurysms underwent embolization by means of the GDC endovascular technique. Ninety-one patients were females and 24 were males. Patient age ranged from 13 to 80 years. In 64 patients the incidental aneurysms were discovered when unrelated nonneurological conditions signaled the need for angiography or magnetic resonance angiography (Group 1). Twenty patients who presented with incidental aneurysms that were discovered during treatment for an acutely ruptured aneurysm underwent treatment of both types of aneurysm during the acute phase of subarachnoid hemorrhage (SAH) (Group 2). Sixteen patients with incidental aneurysms were treated during the chronic phase of SAH (Group 3). Group 4 included 15 patients who had incidental aneurysms associated with brain tumors or arteriovenous malformations.Angiographic results revealed complete or near-complete occlusion in 109 aneurysms (91%) and incomplete occlusion in five aneurysms (4%). Guglielmi detachable coil embolization was attempted unsuccessfully in six aneurysms (5%). One hundred nine patients (94.8%) remained neurologically intact or unchanged from their initial clinical status. Five patients (4.3%) deteriorated as a result of immediate procedural complications. All these complications occurred in the first 50 patients treated in the series. No clinical complications were observed in the last 65 patients. In one patient, a partially embolized aneurysm ruptured 3 years postprocedure. In Groups 1 and 3, the average length of hospitalization was 3.3 days.Conclusions. The evolution of GDC technology has proved to provide safe treatment of incidental aneurysms (a morbidity rate of 0% was achieved in the last 65 patients). The topography of the aneurysm and the clinical condition of the patient did not influence final anatomical or clinical outcomes. The GDC technology also confers a positive economic impact by decreasing hospital length of stay and by eliminating the need for postembolization intensive care.

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Angiographic frequency of anterior circulation intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1989.70.4.0551 ◽

1989 ◽

Vol 70 (4) ◽

pp. 551-555 ◽

Cited By ~ 100

Author(s):

John L. D. Atkinson ◽

Thoralf M. Sundt ◽

O. Wayne Houser ◽

Jack P. Whisnant

Keyword(s):

Intracranial Aneurysms ◽

Age Groups ◽

Low Frequency ◽

Anterior Circulation ◽

Content Type ◽

Clinical Series ◽

High Incidence ◽

Incidental Aneurysms ◽

Minimal Bias ◽

Fine Print

✓ A retrospective angiographic analysis was designed to extrapolate the frequency of angiographically defined asymptomatic intracranial aneurysms in the anterior circulation from a relatively unbiased clinical series. A total of 9295 angiograms were reviewed from January, 1980, to January, 1987, and, based on these, 278 patients with minimal bias for the presence of an aneurysm were selected. Three patients were found to have incidental aneurysms; thus, the angiographic frequency of patients with asymptomatic aneurysms in this series was 1%. This patient population is skewed toward the older age groups and probably over-represents the incidence of these aneurysms in the population at large. Comparing current subarachnoid hemorrhage statistics and the low frequency of asymptomatic aneurysms suggests that a larger percentage of these aneurysms than was previously thought subsequently rupture. This study contrasts sharply with previous reports quoting a high incidence of aneurysms, and significantly alters the concept and treatment of this disease.

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