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Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes
  1. Ali Alawieh1,2,
  2. M Imran Chaudry1,
  3. Raymond D Turner1,
  4. Aquilla S Turk1,
  5. Alejandro M Spiotta1
  1. 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr. Alejandro M Spiotta, Department of Neurosurgery, Medical University of South Carolina, Charleston, SC 29401, USA; spiotta{at}musc.edu

Abstract

Infectious intracranial aneurysms (IIAs) are a rare cerebrovascular complication of systemic infections induced by microbial infiltration and degradation of the arterial vessel wall. Studies on the epidemiology and management of IIAs are limited to case reports and retrospective single-center studies, and report a large variability in epidemiological features, management, and outcomes due to the limited sample size. We conducted a systematic review of all published papers on IIAs in the English literature using MEDLINE and SCOPUS database from January 1950 to June 2017. A total of 288 publications describing 1191 patients with IIA (1398 aneurysms) were included and reviewed for epidemiological features, disease features, treatment and outcome. All patients were merged into a single cohort and summary data are presented. The majority of reported IIAs are distally located, relatively small (<5 mm), involve the anterior circulation, are associated with a relatively high rate of rupture, and demonstrate a propensity to multiplicity of aneurysms. Sensitive diagnosis of IIAs requires digital subtraction angiography and not CT angiography or MR angiography. Treatment of ruptured, symptomatic, or enlarging IIAs has evolved over the last 50 years. Endovascular therapy is associated with a high success rate and low morbidity compared with microsurgical and medical management. A treatment algorithm for the management of patients with IIA in various contexts is proposed and the need for prospective multicenter studies is emphasized.

  • aneurysm
  • infection

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Footnotes

  • Contributors Each author listed should receive authorship credit based on the material contribution to this article, their revision of this article, and their final approval of this article for submission to this journal.

  • Competing interests AMS: Penumbra Consulting, Honorarium, Speaker Bureau; Pulsar Vascular Consulting, Honorarium, Speaker Bureau; Microvention Consulting, Honorarium, Speaker Bureau, Research; Stryker Consulting, Honorarium, Speaker Bureau. AST, RDT, and MIC: Codman Consulting, Honorarium, Speaker Bureau, Research Funding; Covidien Consulting, Honorarium, Speaker Bureau; Penumbra Consulting, Honorarium, Speaker Bureau, Research Grants; Microvention Consulting, Honorarium, Speaker Bureau, Research Grants; Blockade – Stock, Consulting, Honorarium, Speaker Bureau; Pulsar Vascular Stock, Consulting, Honorarium, Speaker Bureau, Research; Medtronic Consulting, Honorarium, Speaker Bureau.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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