Longo Marcello, Granata Francesca, Racchiusa Sergio, Mormina Enricomaria, Grasso Giovanni, Longo Giuseppe Maria, Garufi Giada, Salpietro Francesco M, Alafaci Concetta
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy.
Section of Neurosurgery, Department of Experimental Biomedicine and Clinical Neurosciences (BIONEC), University of Palermo, Palermo, Italy.
World Neurosurg. 2017 Sep;105:632-642. doi: 10.1016/j.wneu.2017.06.035. Epub 2017 Jun 12.
An understanding of the natural history of unruptured intracranial aneurysms (IAs) has always played a critical role in presurgical or endovascular planning, to avoid possibly fatal events. Size, shape, morphology, and location are known risk factors for rupture of an aneurysm, but morphologic parameters alone may not be sufficient to perform proper rupture risk stratification.
We performed a systematic PubMed search and focused on hemodynamics forces that may influence aneurysmal initiation, growth, and rupture.
We included 223 studies describing several hemodynamic parameters related to aneurysm natural history. In these studies, different modalities of aneurysm model creation have been used to evaluate flow and to comprehensively analyze the evolution of IAs. Controversy exists about the correlation between these parameters and initiation, growth, rupture risk, or stabilization of the aneurysmal sac. Recent findings have also shown the importance of flow patterns in this process and the relationship between unruptured IA geometry and hemodynamic parameters.
The role of hemodynamic forces in evaluation of the natural history of unruptured IAs presents is inherently complex and is still not completely understood. In this complex scenario, although several attempts have been described in the literature, a proper risk rupture stratification and treatment strategy selection based on hemodynamic forces has not yet been created. Further efforts should be made to accomplish this important goal.
了解未破裂颅内动脉瘤（IA）的自然病史在术前或血管内治疗规划中一直起着关键作用，以避免可能的致命事件。大小、形状、形态和位置是已知的动脉瘤破裂危险因素，但仅形态学参数可能不足以进行准确的破裂风险分层。
我们对PubMed进行了系统检索，重点关注可能影响动脉瘤起始、生长和破裂的血流动力学因素。
我们纳入了223项描述与动脉瘤自然病史相关的几个血流动力学参数的研究。在这些研究中，已使用不同的动脉瘤模型创建方式来评估血流并全面分析IA的演变。这些参数与动脉瘤囊的起始、生长、破裂风险或稳定之间的相关性存在争议。最近的研究结果还表明了血流模式在此过程中的重要性以及未破裂IA几何形状与血流动力学参数之间的关系。
血流动力学因素在评估未破裂IA自然病史中的作用本质上很复杂，目前仍未完全理解。在这种复杂情况下，尽管文献中已有一些尝试，但尚未建立基于血流动力学因素的适当破裂风险分层和治疗策略选择方法。应进一步努力实现这一重要目标。
