Abstract
Subarachnoid hemorrhage is the most devastating clinical presentation of intracranial aneurysms, which makes it desirable to treat them before they bleed. Because this apoplectic event leaves most survivors with neurological deficits, we aim to define high-risk criteria for rupture based on our series.
We retrospectively analyzed 383 cases of treated unruptured aneurysms between January 1999 and December 2002, sixty-four of whom received coil embolization. Treatment indications were previous SAH, presence of bleb, symptomatic aneurysms, size more than 5 mm, posterior circulation, irregular dome wall and high-amplitude bleb-site pulsatility on 4D-CTA. Intraoperative aneurysm wall resection was performed and histological examination done.
The outcome was good in all cases after clipping and coiling; there were no cases of mortality or permanent morbidity. Immunostaining and histopathology verified loss of tunica media muscle coat and elastic lamina at the bleb site with smooth muscle actin and Type IV collagen positivity in 15 cases of aneurysm resection.
Screening with 4D-CTA or 3D-CTA are noninvasive methods that can be employed in first degree relative of SAH patients and those with risk factors. Symptomatic aneurysms need treatment as a priority; direct surgery and coiling are recommended in unruptured aneurysms. Prediction of rupture point based on 4D-CTA is confirmed histologically.
