Figure 1: This is a lateral projection angiogram of the internal carotid artery. It demonstrates a tri-lobed ("Mickey Mouse") aneurysm originating from the distal anterior cerebral artery
Figure 2: This is a post-operative angiogram demonstrating obliteration of the aneurysm by a surgical clip, which can be readily identified
Intracranial aneurysms occur at "weak spots" in the wall of intracranial arteries (Figure 1). They can expand over time, particularly in patients with risk factors such as diabetes mellitus, hypertension, smoking history, and collagen vascular diseases. Intracranial aneurysms can rupture, which most commonly causes subarachnoid hemorrhage, a type of bleeding around the base of the brain in the space that normally houses cerebrospinal fluid. The rupture of an intracranial aneurysm is often a devastating event, and many patients do not survive the initial hemorrhage. Of those patients that do survive the initial hemorrhage, only approximately 30% ever return to work or fully independent, functional status. Because of the severity of this disease, the identification of an intracranial aneurysm in an asymptomatic patient often warrants treatment.
The treatment of intracranial aneurysms has evolved substantially over the past two decades. In the past, aneurysms were treated with direct surgical obliteration of the lesion or direct sacrifice of the parent artery that contained the aneurysm. These procedures initially had extremely high complication rates. The development of endovascular techniques over the past two decades now allows the treatment of intracranial aneurysms from within the blood vessel, typically by occluding the vessel with platinum coils that induce the aneurysm to clot, or by occluding the aneurysm neck with a stent. These techniques are highly specialized and are performed by an Interventional Neuroradiologist, which requires many years of additional training beyond that of a standard radiologist, or even a general interventional radiologist.
Although endovascular techniques have markedly improved patient care regarding the treatment of intracranial aneurysms, microsurgical techniques have also evolved substantially in the recent past as well. Although many types of aneurysms can be permanently occluded with endovascular techniques, aneurysms located in certain difficult-to-reach areas of the brain, and certain aneurysms with complex configurations are best addressed with direct, open surgical clip reconstructions (Figure 2). The evaluation of the aneurysm patient requires direct collaboration between that of a Cerebrovascular Neurosurgeon and an Interventional Neuroradiologist. This allows the development of the best treatment plan possible, tailored to the specific needs of the patient based on their aneurysm location and configuration. The Cerebrovascular Division of Ft. Smith Neuroscience Center provides comprehensive management of patients with intracranial aneurysms and other cerebrovascular diseases, such as arteriovenous malformations, cavernous malformations, dural arteriovenous fistulas, and internal carotid artery stenosis.
Fort Smith Neuroscience Center