Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms

Analysis and comparison of trends in the burden of subarachnoid hemorrhage in china and globally, 1990-2021

BACKGROUND

Subarachnoid hemorrhage (SAH), the rarest form of hemorrhagic stroke, is associated with high mortality and disability rates. Therefore, it is a major public health concern.

METHODS

This study reviewed the epidemiological characteristics of SAH in China and worldwide, focusing on the 2021 Global Burden of Disease (GBD) database. Researchers, using the GBD database, conducted epidemiological studies that included joinpoint regression analyses covering the incidence, mortality, prevalence, and disability-adjusted life years of SAH in the years 1990-2021. This analysis revealed the trends and effects of SAH in China and globally.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) in China decreased from 17.96 to 7.81 per 100,000 people. The age-standardized mortality rate (ASMR) decreased from 27.29 to 4.72 per 100,000 people. This resulted in a 51.58 % reduction in mortality. In contrast, both the ASIR and ASMR showed a slower decline at the global level. China has reported that women aged 70 years and older are at a high risk for SAH. Furthermore, middle-aged men have high prevalence and mortality rates.

CONCLUSIONS

The current observations warrant the design of focused interventions for both the elderly and female patients with oblique stroke. They can be useful for addressing the SAH burden globally. This study provides valuable information regarding the effectiveness of existing healthcare interventions. This information can also inform future strategies for the prevention and management of SAH.

Study and Therapeutic Progress on Intracranial Serpentine Aneurysms

An intracranial serpentine aneurysm (SA) is a clinically rare entity, and very few multi-case studies on SA have been published. The present study reviewed the relevant literature available on PubMed. The studied information included the formation mechanism and natural history of SA as well as its clinical manifestation, imaging characteristics, and current treatments. After reviewing the literature, we conclude that intracranial SA can be managed surgically and by endovascular embolization, but the degree of blood flow in normal brain tissue distal to the SA must be evaluated. A balloon occlusion test (BOT) or cross compression test is recommended for this evaluation. If the collateral circulation is sufficiently compensatory, direct excision or embolization can be performed. However, if the compensatory collateral circulation is poor, a bypass surgery is necessary. Satisfactory results can be achieved in the majority of SA patients after treatment. However, the size of the aneurysm may increase in some patients after endovascular treatment. Special attention should be paid to cases exhibiting a significant mass effect to avoid subsequent SA excision due to an intolerable mass effect. Satisfactory results can be achieved with careful treatment of SA.

Unraveling of the Effect of Nodose Ganglion Degeneration on the Coronary Artery Vasospasm After Subarachnoid Hemorrhage: An Experimental Study

BACKGROUND

Cardiac arrest is a major life-threatening complication of subarachnoid hemorrhage (SAH). Although medullary cardiocirculatuar center injury and central sympathetic overactivity have been suspected of initiating coronary artery spasm-induced cardiac arrest, we aimed to elucidate the effects of vagal ischemia at the brainstem on coronary vasospasm and sudden death in SAH.

METHODS

Twenty-six rabbits were randomly divided into 3 groups. Control (n = 5); SHAM (n = 8), and SAH group (n = 13). Experimental SAH was applied by injecting homologous blood into the cisterna magna, and the SHAM group was injected with isotonic saline solution also in the cisterna magna., Twenty-one days after the injection, histopathologic changes of the neuron density of nodose ganglia, the vasospasm index values of the coronary arteries, and the electrocardiographic events were analyzed.

RESULTS

Increased vasospasm index of the coronary arteries and degenerated neuron density of nodose ganglion were significantly different between animals with SAH, control, and SHAM groups (P < 0.005). If neurons of the nodose ganglia are lesioned due to ischemic insult during SAH, the heart rhythm regulation by vagus afferent reflexes is disturbed.

CONCLUSIONS

We found that there is causal relationship between nodose ganglion degeneration and coronary vasospasm. Our finding could be the reason that many cardiac events occur in patients with SAH. Vagal pathway paralysis induced by indirect sympathetic overactivity may trigger coronary vasospasm and heart rhythm disturbances. Our findings will aid in the planning of future experimental studies and in determining the clinical relevance of such studies.