Jason A Ellis1, Erez Nossek1,2, Annick Kronenburg3, David J Langer1, Rafael A Ortiz4. 1. Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, 130 E 77th Street, 3rd Floor, New York, NY, 10075, USA. 2. Division of Neurosurgery, Maimonides Medical Center, Brooklyn, NY, USA. 3. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands. 4. Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, 130 E 77th Street, 3rd Floor, New York, NY, 10075, USA. Rortiz3@northwell.edu.
Abstract
PURPOSE OF REVIEW: Cerebral aneurysms are commonly diagnosed incidentally with non-invasive neuro-imaging modalities (i.e., brain MRA and/or head CTA). The first decision to be made in the management of patients with unruptured cerebral aneurysms is to determine if the aneurysm should undergo treatment as any intervention carries a risk of morbidity and mortality. RECENT FINDINGS: The multiple risk factors that are associated with increased risk of aneurysm rupture should be evaluated (size, shape, and location of aneurysm; history of hypertension and cigarette smoking and family history of cerebral aneurysms). With the advent and rapid evolution of less traumatic neuro-endovascular surgery techniques in the past two decades, many more patients are undergoing treatment of cerebral aneurysms. The neuro-endovascular surgeon has multiple options for the treatment of aneurysms including coiling, with or without balloon/stent assistance, and flow diversion. A number of intrasaccular devices for the neuro-endovascular treatment of cerebral aneurysms are being evaluated. The percentage of patients with cerebral aneurysms treated with craniotomy and clip ligation is decreasing. This is controversial as it has direct impact in neurosurgical training and the aneurysms that are usually recommended for microsurgical clipping are the ones with challenging anatomy that cannot be treated safely with endovascular approaches. The best outcomes are achieved with management by experienced, high-volume practitioners at specialized cerebrovascular treatment centers that consist of individuals with dedicated training in neuro-endovascular surgery as well as individuals trained in open cerebrovascular neurosurgery.
PURPOSE OF REVIEW: Cerebral aneurysms are commonly diagnosed incidentally with non-invasive neuro-imaging modalities (i.e., brain MRA and/or head CTA). The first decision to be made in the management of patients with unruptured cerebral aneurysms is to determine if the aneurysm should undergo treatment as any intervention carries a risk of morbidity and mortality. RECENT FINDINGS: The multiple risk factors that are associated with increased risk of aneurysm rupture should be evaluated (size, shape, and location of aneurysm; history of hypertension and cigarette smoking and family history of cerebral aneurysms). With the advent and rapid evolution of less traumatic neuro-endovascular surgery techniques in the past two decades, many more patients are undergoing treatment of cerebral aneurysms. The neuro-endovascular surgeon has multiple options for the treatment of aneurysms including coiling, with or without balloon/stent assistance, and flow diversion. A number of intrasaccular devices for the neuro-endovascular treatment of cerebral aneurysms are being evaluated. The percentage of patients with cerebral aneurysms treated with craniotomy and clip ligation is decreasing. This is controversial as it has direct impact in neurosurgical training and the aneurysms that are usually recommended for microsurgical clipping are the ones with challenging anatomy that cannot be treated safely with endovascular approaches. The best outcomes are achieved with management by experienced, high-volume practitioners at specialized cerebrovascular treatment centers that consist of individuals with dedicated training in neuro-endovascular surgery as well as individuals trained in open cerebrovascular neurosurgery.
Authors: Erez Nossek; Daniel W Zumofen; Avi Setton; Matthew B Potts; Eytan Raz; Maksim Shapiro; Howard A Riina; Maria Angeles De Miquel; David J Chalif; Peter K Nelson Journal: J Clin Neurosci Date: 2016-11-15 Impact factor: 1.961
Authors: B Gregory Thompson; Robert D Brown; Sepideh Amin-Hanjani; Joseph P Broderick; Kevin M Cockroft; E Sander Connolly; Gary R Duckwiler; Catherine C Harris; Virginia J Howard; S Claiborne Clay Johnston; Philip M Meyers; Andrew Molyneux; Christopher S Ogilvy; Andrew J Ringer; James Torner Journal: Stroke Date: 2015-06-18 Impact factor: 7.914