Symposium on Cerebrovascular DiseasesPathogenesis, Natural History, and Treatment of Unruptured Intracranial Aneurysms
Section snippets
PATHOGENESIS
Approximately 80% to 90% of all intracranial aneurysms are classified as saccular or berry aneurysms, which normally appear as small, rounded, berrylike dilatations. Other shapes (sessile, pedunculated, multilobed) also are seen. Multiple aneurysms occur in 20% to 25% of patients with saccular aneurysms, and approximately 20% of patients with saccular aneurysms have a family history of SAH or intracranial aneurysms.14 Various other pathological entities have been associated with intracranial
GROWTH AND RUPTURE OF ANEURYSMS
Much controversy exists about the mechanisms involved with the growth and rupture of intracranial aneurysms. An understanding of such mechanisms is necessary to optimize our knowledge of the clinical behavior of these lesions and to optimize treatment of patients with UIAs.
Because of the risk associated with arteriographic studies over the years, relatively little information regarding serial angiography of UIAs is available.48, 49, 50, 51 Existing data seem to indicate wide variability in the
NATURAL HISTORY STUDIES
Clinical data concerning the natural history of UIAs are best considered separately for patients with UIAs and without prior SAH and patients with UIAs and prior SAH from a different aneurysm.
PATHOPHYSIOLOGY OF ANEURYSMAL DEVELOPMENT, GROWTH, AND RUPTURE
Over the years, some investigators have called attention to patients with small ruptured aneurysms diagnosed after SAH, inferring that small UIAs, even in group 1, may have substantial rupture rates.78 Others have attempted to extrapolate the natural history of UIAs by considering incidence rates of SAH to infer prevalences of UIAs in the population.79 It is important to recognize that ruptured intracranial aneurysms and UIAs constitute distinctly different clinical entities and need to be
TREATMENT CONSIDERATIONS
Patient treatment decisions involve consideration of not only the natural history of UIAs but also the morbidity and mortality rates associated with treatment including direct surgery and endovascular methods.
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