title: Intracranial aneurysms: from vessel wall pathology to therapeutic approach.
abstract: An aneurysm is a focal dilatation of an arterial blood vessel. Luminal forces, such as high blood flow, shear stress and turbulence, are implicated in the pathogenesis of intracranial aneurysms, and luminal characteristics, such as sac size and morphology, are usually essential to the clinical decision-making process. Despite frequent clinical emphasis on the vessel lumen, however, the pathology underlying the formation, growth and rupture of an aneurysm mainly resides in the vessel wall. Research on the morphology and histopathology of the vessel wall reveals that intracranial aneurysms do not constitute a single disease, but are a shared manifestation of a wide range of diseases, each of which has a unique natural history and optimum therapy. This Review classifies intracranial aneurysms by vessel wall pathology, and demonstrates that understanding the morphology and pathology of this structure is important in determining the therapeutic approach. The article concludes that aneurysms represent a symptom of an underlying vascular disease rather than constituting a disease on their own.
authors.affiliation: Division of Neuroradiology, Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada. timo.krings@uhn.ca
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Mandell
authors.forename: Tim-Rasmus
authors.initials: TR
authors.lastname: Kiehl
authors.forename: Sasikhan
authors.initials: S
authors.lastname: Geibprasert
authors.forename: Michael
authors.initials: M
authors.lastname: Tymianski
authors.forename: Hortensia
authors.initials: H
authors.lastname: Alvarez
authors.forename: Karel G
authors.initials: KG
authors.lastname: terBrugge
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Hans
mesh_terms: D001808:Blood Vessels / Q000473:pathology*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000628:therapy*; D013525:Surgical Instruments