In this video, Dr. Bailey reviews intracranial aneurysms, including an overview of what an aneurysm is, how to find them, and tips for searching for aneurysms. The first part of this video covers general principles of aneurysm evaluation and the second part shows 3 sample cases that you can go through to test your individual skills.
Introduction and definition of aneurysm
An aneurysm is an abnormal outpouching of the intracranial vessel. Intracranial aneurysms are true aneurysms, which typically involve all of the layers of the vessel. To find aneurysms, a type of vascular imaging known as an angiogram (which can also be done with CT or MRI) is done to evaluate the arteries.
How to find aneurysms
To find aneurysms, you should be looking for an abnormal dilation of the vessel. Then you should look at the most common locations, which are the anterior communicating artery, the carotid terminus/posterior communicating artery, the middle cerebral artery, and the posterior circulation/basilar tip.
Saccular versus fusiform aneurysm
Saccular aneurysms are the most common type of aneurysm. They are rounded outpouchings of the vessel. Fusiform aneurysms are circumferential areas of enlargement of the vessel, meaning the whole diameter is increased.
Sometimes aneurysms can be thrombosed, meaning they no longer have blood flow. In these cases, their imaging appearance can change, and they may not show up on angiographic imaging.
Tips for reporting aneurysms
When creating a report about an aneurysm, you should describe where the aneurysm is, which direction it points, and its size. It’s common to measure three sizes, the maximal width, the height, and the width at the neck.
The two most common treatments for aneurysm are surgical clipping, in which a clamp is placed over the base of the aneurysm, and endovascular coiling, in which small coils are placed within the vessel from inside. It is also possible to use stents to treat aneurysms, either in combination with coils or alone.
Take a crack at 3 practice cases at the end of the video.
Hopefully you learned a little bit about finding and reporting intracranial aneurysms. Please check out the additional vascular videos on the site, including the video on 5 quick ways to improve your aneurysm search pattern.
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