Update on the Management of Brain Aneurysms

70 Pages·2017·7.35 MB·English

by  Brian Auderer

Update on the Management
of Brain Aneurysms
Olympic Peninsula Medical Conference
Port Angeles, WA
November 10, 2017
Roby Ryan, MD
Endovascular Neurosurgeon
Virginia Mason Neuroscience Institute
Disclosures
• No financial disclosures
© 2016 Virginia Mason Medical Center
Things aren’t always what they seem…
WTF – Welcome to Fresno
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Things aren’t always what they seem…
?
© 2016 Virginia Mason Medical Center
Objectives
1. Review the incidence and natural history of brain
aneurysms
2. Discuss steps in clinical identification of brain aneurysms
and their early management, including diagnostic tests
and referrals
3. Learn to identify patients that are good candidates for
endovascular coiling or surgical clipping and apply this to
achieve better patient outcomes
© 2016 Virginia Mason Medical Center
Cerebral aneurysm - definition
• a focal dilation of an artery wall
• Represents a weak spot – lacks normal layers (muscle and
internal elastic lamina)
• Most common are “sacular” or “berry”; also fusiform,
blister, infectious
Blister aneurysm
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2 major categories:
Unruptured Ruptured
– Usually no symptoms – Subarachnoid
Hemorrahge
– May press on a cranial
nerve (eg. 3rd n. palsy) – Emergency treatment
– Elective treatment
© 2016 Virginia Mason Medical Center
Aneurysm formation
Luminal factors Vessel Wall factors
– Hemodynamic factors – Loss of IEL
• HYPERTENSION – Genetic factors
– Shear stress
– Connective tissue dx
– Branch point location
– SMOKING
– Point direction blood goes
– ?Methamphetamine
Krings, et. al, Nat. Rev Neurol, 2011
© 2016 Virginia Mason Medical Center
Aneurysm formation
Gap junctions
Branch points
© 2016 Virginia Mason Medical Center
Aneurysm classification: location
© 2016 Virginia Mason Medical Center