Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes

Area of Science:

• Neurology
• Vascular Surgery
• Infectious Diseases

Background:

• Infectious intracranial aneurysms (IIAs) are uncommon cerebrovascular complications arising from systemic infections.
• Existing research is limited to small case reports and retrospective studies, leading to varied understanding of IIA epidemiology and management.
• A comprehensive understanding of IIA characteristics and optimal treatment strategies is lacking.

Purpose of the Study:

• To systematically review and synthesize data on the epidemiology, clinical features, treatment, and outcomes of infectious intracranial aneurysms.
• To consolidate findings from existing literature to provide a larger cohort for analysis.
• To propose a management algorithm and highlight areas for future research.

Main Methods:

• A systematic literature search was performed using MEDLINE and SCOPUS databases for English-language publications on IIAs from January 1950 to June 2017.
• Data from 288 publications, encompassing 1191 patients and 1398 aneurysms, were extracted and analyzed.
• Epidemiological features, disease characteristics, treatment modalities, and patient outcomes were reviewed.

Main Results:

• The majority of IIAs were found in the distal locations, primarily affecting the anterior circulation, and were relatively small (<5 mm).
• A significant proportion of IIAs were associated with a high rupture rate and a tendency for multiplicity.
• Digital subtraction angiography was identified as the most sensitive diagnostic tool, surpassing CT angiography and MR angiography.
• Endovascular therapy demonstrated a high success rate and lower morbidity compared to microsurgical and medical interventions.

Conclusions:

• Infectious intracranial aneurysms present with specific characteristics, including distal location, anterior circulation involvement, and a propensity for rupture and multiplicity.
• Digital subtraction angiography is crucial for sensitive diagnosis of IIAs.
• Endovascular treatment is an effective and safe option for managing IIAs, offering better outcomes than traditional methods.
• Prospective multicenter studies are essential to further elucidate IIA management and improve patient outcomes.