Neurointervention.  2018 Sep;13(2):73-83. 10.5469/neuroint.2018.01011.

New Pathophysiological Considerations on Cerebral Aneurysms

• Jung KH

• KMID: 2424055
• DOI: http://doi.org/10.5469/neuroint.2018.01011

Abstract

Cerebral aneurysm is a common cerebrovascular disease that is sometimes complicated by rupture or an enlarged mass. We are now aggressively evaluating and managing unruptured cerebral aneurysms based on a significant concern for the high morbidity and mortality related to its associated complications. However, the actual rupture rate is very low and the diagnostic and treatment modalities are expensive and invasive, which may lead to unnecessary costs and potential medical complications. This disproportionate situation is related to a poor understanding of the natural course and pathophysiology of cerebral aneurysms. In consideration of the concept that not all cerebral aneurysms must be removed, we need to examine their course and progression more accurately. Cerebral aneurysms may follow a variety of pathophysiological scenarios over their lifetime, from formation to growth and rupture. The disease course and the final outcome can differ depending on the timing and intensity of the pathological signals acting on the cerebral vessel wall. We should delineate a method of predicting the stability and risk of rupture of the lesion based on a comprehensive knowledge of the vessel wall integrity. This review deals with the basic knowledge and advanced concepts underlying the pathophysiology of cerebral aneurysms.

Keyword

Cerebral aneurysm; Pathophysiology; Risk factors; Outcome

MeSH Terms

Cerebrovascular Disorders
Intracranial Aneurysm*
Methods
Mortality
Risk Factors
Rupture

Figure

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  Fig. 1. Structural alteration of a cerebral aneurysm. Intracranial arteries are normally composed of firm layers, including endothelial cell, internal elastic lamina, smooth muscle cells, extracellular matrices, and adventitia. Meanwhile, aneurysmal changes result from perturbations of one or more of these components.

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  Fig. 2. Cerebral aneurysms with eccentric features associated with intrinsic vessel wall deformities A 55-year old woman was admitted because of an aneurysmal subarachnoid hemorrhage (SAH) in the right sylvian fissure (A). A large aneurysm in the right middle cerebral artery (MCA) was considered as a culprit lesion of SAH (B). However, multiple, large aneurysms were also noted in the anterior communicating and anterior cerebral arteries (C), and basilar artery (D). The second patient was a 53-year old woman complaining of anterior chest discomfort. Computed tomography angiography showed a large aneurysm involving the descending thoracic aorta (E, F). An intracranial aneurysm was also detected in the right MCA bifurcation from the screening magnetic resonance angiography (G).

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  Fig. 3. Risk factor domains to predict outcomes of cerebral aneurysm. A multi-factorial model can be applied to predict outcomes of a cerebral aneurysm. This model is based on patient- and aneurysm-specific factors with potential systemic markers.

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