Intracranial aneurysms
| Intracranial aneurysms |
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Overview
The catastrophic potential of intracranial aneurysms, arteriovenous malformations (AVMs), and arteriovenous fistulas (AVFs) and the complexity of their pathogenesis have made them the subject of intense interest and study over the past 80 years. Advances in the ability to treat these lesions have been paralleled by rigorous research on their pathophysiology. An increase in the longevity of the population over the past century and improvements in imaging techniques contribute to more frequent encounters with these lesions by neurosurgeons and interventionists. Despite numerous clinical and laboratory research projects studying the pathophysiology of these lesions, much remains to be learned. In this chapter, we will discuss the pathophysiology of various types of intracranial aneurysms, as well as AVMs and AVFs.
Berry Aneurysms
Berry aneurysms arise at vessel bifurcations or curves. These aneurysms occur mostly between the ages of 40 and 70 years. The pathogenesis of berry aneurysms is multifactorial. Compelling evidence suggests that hemodynamic factors as well as degenerative histological changes in the parent vessel wall contribute to aneurysm formation. Early in the process of berry aneurysm formation, destruction and eventual loss of the media occur (1). The internal elastic layer becomes disrupted and is eventually lost.