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Saccular Aneurysm
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Intracranial saccular aneurysm (SA)
          • Synonyms

            • Berry aneurysm, true aneurysm
          • Definitions

            • Arterial outpouching affecting only part of arterial circumference
              • Lacks internal elastic lamina ± tunica media
            • "Wide-neck" aneurysm
              • Neck size ≥ 4 mm or
              • Dome:neck ratio < 2

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Angiographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Castle-Kirszbaum M et al: Four-dimensional magnetic resonance imaging assessment of intracranial aneurysms: a state-of-the-art review. Neurosurgery. ePub, 2020
                                        2. Hernández-Durán S et al: Is the unruptured intracranial aneurysm treatment score (UIATS) sensitive enough to detect aneurysms at risk of rupture? Neurosurg Rev. ePub, 2020
                                        3. Malhotra A et al: Management of small, unruptured intracranial aneurysms. World Neurosurg. 135:379-80, 2020
                                        4. Pierot L et al: Intraoperative complications of endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1088 participants: analysis of recanalization after endovascular treatment of intracranial aneurysm (ARETA) Study. Radiology. 191842, 2020
                                        5. Shi Z et al: Artificial intelligence in the management of intracranial aneurysms: current status and future perspectives. AJNR Am J Neuroradiol. 41(3):373-9, 2020
                                        6. Warchol-Celinska E et al: Systematic and multidisciplinary evaluation of fibromuscular dysplasia patients reveals high prevalence of previously undetected fibromuscular dysplasia lesions and affects clinical decisions: the ARCADIA-POL study. Hypertension. 75(4):1102-9, 2020
                                        7. Dmytriw AA et al: On flow diversion: the changing landscape of intracerebral aneurysm management. AJNR Am J Neuroradiol. 40(4):591-600, 2019
                                        8. Kern KC et al: Vessel wall imaging of cerebrovascular disorders. Curr Treat Options Cardiovasc Med. 21(11):65, 2019
                                        9. Samaniego EA et al: Vessel wall imaging in intracranial aneurysms. J Neurointerv Surg. 11(11):1105-12, 2019
                                        10. Texakalidis P et al: Aneurysm formation, growth, and rupture: the biology and physics of cerebral aneurysms. World Neurosurg. 130:277-84, 2019
                                        11. Signorelli F et al: Hemodynamic stress, inflammation, and intracranial aneurysm development and rupture: a systematic review. World Neurosurg. 115:234-44, 2018
                                        12. Tulamo R et al: Inflammatory changes in the aneurysm wall: a review. J Neurointerv Surg. 10(Suppl 1):i58-i67, 2018
                                        13. Malhotra A et al: Growth and rupture risk of small unruptured intracranial aneurysms: a systematic review. Ann Intern Med. 167(1):26-33, 2017
                                        14. Hu P et al: Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology. 58(10):979-85, 2016
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Intracranial saccular aneurysm (SA)
                                                • Synonyms

                                                  • Berry aneurysm, true aneurysm
                                                • Definitions

                                                  • Arterial outpouching affecting only part of arterial circumference
                                                    • Lacks internal elastic lamina ± tunica media
                                                  • "Wide-neck" aneurysm
                                                    • Neck size ≥ 4 mm or
                                                    • Dome:neck ratio < 2

                                                IMAGING

                                                • General Features

                                                  • CT Findings

                                                    • MR Findings

                                                      • Angiographic Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Castle-Kirszbaum M et al: Four-dimensional magnetic resonance imaging assessment of intracranial aneurysms: a state-of-the-art review. Neurosurgery. ePub, 2020
                                                                              2. Hernández-Durán S et al: Is the unruptured intracranial aneurysm treatment score (UIATS) sensitive enough to detect aneurysms at risk of rupture? Neurosurg Rev. ePub, 2020
                                                                              3. Malhotra A et al: Management of small, unruptured intracranial aneurysms. World Neurosurg. 135:379-80, 2020
                                                                              4. Pierot L et al: Intraoperative complications of endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1088 participants: analysis of recanalization after endovascular treatment of intracranial aneurysm (ARETA) Study. Radiology. 191842, 2020
                                                                              5. Shi Z et al: Artificial intelligence in the management of intracranial aneurysms: current status and future perspectives. AJNR Am J Neuroradiol. 41(3):373-9, 2020
                                                                              6. Warchol-Celinska E et al: Systematic and multidisciplinary evaluation of fibromuscular dysplasia patients reveals high prevalence of previously undetected fibromuscular dysplasia lesions and affects clinical decisions: the ARCADIA-POL study. Hypertension. 75(4):1102-9, 2020
                                                                              7. Dmytriw AA et al: On flow diversion: the changing landscape of intracerebral aneurysm management. AJNR Am J Neuroradiol. 40(4):591-600, 2019
                                                                              8. Kern KC et al: Vessel wall imaging of cerebrovascular disorders. Curr Treat Options Cardiovasc Med. 21(11):65, 2019
                                                                              9. Samaniego EA et al: Vessel wall imaging in intracranial aneurysms. J Neurointerv Surg. 11(11):1105-12, 2019
                                                                              10. Texakalidis P et al: Aneurysm formation, growth, and rupture: the biology and physics of cerebral aneurysms. World Neurosurg. 130:277-84, 2019
                                                                              11. Signorelli F et al: Hemodynamic stress, inflammation, and intracranial aneurysm development and rupture: a systematic review. World Neurosurg. 115:234-44, 2018
                                                                              12. Tulamo R et al: Inflammatory changes in the aneurysm wall: a review. J Neurointerv Surg. 10(Suppl 1):i58-i67, 2018
                                                                              13. Malhotra A et al: Growth and rupture risk of small unruptured intracranial aneurysms: a systematic review. Ann Intern Med. 167(1):26-33, 2017
                                                                              14. Hu P et al: Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology. 58(10):979-85, 2016