Department of Pathology and Immunology, Faculty of Medicine, Centre Medical Universitaire, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland.
Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Neurosurg Rev. 2022 Apr;45(2):1233-1253. doi: 10.1007/s10143-021-01672-5. Epub 2021 Nov 6.
Intracranial aneurysm (IA), a local outpouching of cerebral arteries, is present in 3 to 5% of the population. Once formed, an IA can remain stable, grow, or rupture. Determining the evolution of IAs is almost impossible. Rupture of an IA leads to subarachnoid hemorrhage and affects mostly young people with heavy consequences in terms of death, disabilities, and socioeconomic burden. Even if the large majority of IAs will never rupture, it is critical to determine which IA might be at risk of rupture. IA (in)stability is dependent on the composition of its wall and on its ability to repair. The biology of the IA wall is complex and not completely understood. Nowadays, the risk of rupture of an IA is estimated in clinics by using scores based on the characteristics of the IA itself and on the anamnesis of the patient. Classification and prediction using these scores are not satisfying and decisions whether a patient should be observed or treated need to be better informed by more reliable biomarkers. In the present review, the effects of known risk factors for rupture, as well as the effects of biomechanical forces on the IA wall composition, will be summarized. Moreover, recent advances in high-resolution vessel wall magnetic resonance imaging, which are promising tools to discriminate between stable and unstable IAs, will be described. Common data elements recently defined to improve IA disease knowledge and disease management will be presented. Finally, recent findings in genetics will be introduced and future directions in the field of IA will be exposed.
颅内动脉瘤（IA）是脑动脉的局部膨出，在人群中的发生率为 3%至 5%。一旦形成，IA 可以保持稳定、生长或破裂。确定 IA 的演变几乎是不可能的。IA 的破裂会导致蛛网膜下腔出血，主要影响年轻人，导致死亡、残疾和社会经济负担等严重后果。即使大多数 IA 永远不会破裂，确定哪些 IA 可能有破裂风险也是至关重要的。IA（不）稳定性取决于其壁的组成及其修复能力。IA 壁的生物学非常复杂，尚未完全理解。目前，IA 破裂的风险是通过使用基于 IA 本身特征和患者病史的评分来评估的。这些评分的分类和预测并不令人满意，需要更可靠的生物标志物来更好地告知是否需要对患者进行观察或治疗。在本综述中，将总结已知的破裂风险因素的影响，以及生物力学力对 IA 壁组成的影响。此外，还将描述高分辨率血管壁磁共振成像的最新进展，这是一种有前途的工具，可以区分稳定和不稳定的 IA。将介绍最近定义的用于改善 IA 疾病知识和疾病管理的常见数据元素。最后，将介绍遗传学的最新发现，并揭示 IA 领域的未来发展方向。
