Preoperative Management of Patients with Intra-Cranial Aneurysms

Abstract

Aneurysms of the intra-cranial vessels are congenital or acquired lesions related to a structural defect in the media of the arterial wall. They arise as sac-like outpouchings at the apices of major arterial bifurcations. 85% occur on the anterior circulation and 15% on the posterior circulation.

The flow characteristics at these bifurcations lead to progressive dilatation of the aneurysural sac. Rupture is often associated with sudden rise in blood pressure as may occur during a valsalva maneuver or physical and mental stress. It can also occur during sleep. Rupture of an aneurysm leads to leakage of blood into the subarachnoid space giving use to symptoms of severe headache, nausea, vomiting or loss of consciousness. Neurogenic pulmonary oedema may also occur.