Diagnosticul şi managementul anevrismului arterial intracerebral

Abstract

Background: Intracranial aneurysms are a major socio-economic and public health problem for the twenty-first century. Increasing incidence, mortality and morbidity from stroke, due to ruptured aneurysm, accessibility to diagnostic methods and permanently improved microsurgical approaches, which have revolutionized the surgical treatment of intracranial aneurysms and obviously changed the evolution and prognosis of operated patients, warrants attention to the intracerebral aneurysms. Review article examines the contemporary literature on the prevalence, incidence, classification, morphological characteristics, location and natural history of intracranial aneurysms (undetected asymptomatic, symptomatic with signs of compression of the brain substance, aneurysmal rupture with subarachnoid, intraventricular or intraparenchymal hemorrhage). Article examines the effectiveness of contemporary diagnostic techniques for the intracranial aneurysms (multislice computed tomography angiography and magnetic resonance angiography), verified by the methods of conventional catheter angiography, the results of autopsy studies and intraoperative estimates. We evaluated treatment methods and tactics of this group of patients. Conclusions: Th e prevalence of intracranial aneurysms varies considerably depending on the pattern of study, population characteristics evaluated and type of aneurysm. In adult population without risk factors for subarachnoid hemorrhage, aneurysms are detected in about 2% of cases. Subarachnoid hemorrhage mortality in the first month after aneurysm rupture varies from 25% to 67%, including the death of 12.8% of patients before receiving medical assistance and aneurysmal rebleeding is associated with a mortality of 60%. About 50% of survived patients possess neurological deficiencies, including major and require long recovery, physical therapy, occupational and speech rehabilitation.