Nicht rupturierte intrakranielle Aneurysmen: wann suchen, wann behandeln?

Zusammenfassung

Durch die Verbreitung von Schnittbildverfahren mit angiografischen Rekonstruktionen hat die Häufigkeit zugenommen, mit der Aneurysmen hirnversorgender Arterien diagnostiziert werden. Zudem werden Untersuchungen nicht selten von Personen gewünscht, bei deren Verwandten ein Aneurysma oder eine Subarachnoidalblutung diagnostiziert wurde. Der Umgang mit diesem Themen ist für jeden Radiologen bedeutsam und wird hier anhand der neueren Literatur diskutiert. Die Prävalenz von Aneurysmen in der Normalbevölkerung beträgt etwa 2 – 3 %, steigt mit einem Verwandten ersten Grades mit einem Aneurysma auf etwa 4 – 10 % und bei mindestens zwei Verwandten mit Aneurysma auf etwa 20 %. Das Rupturrisiko ist insgesamt bei durchschnittlich etwa 5 % in einem 5-Jahreszeitraum anzusiedeln, ist jedoch tatsächlich sehr variabel und abhängig von individuell zu diskutierenden Faktoren. Das Risiko einer endovaskulären Behandlung liegt nach Literaturdaten bei unter 5 %, wobei für die Risikoabwägung immer die Ergebnisse des jeweiligen Behandlungszentrums herangezogen werden müssen. Die Notwendigkeit eines MRA-Screenings sollte in Kenntnis all dieser Daten individuell mit dem Patienten diskutiert werden.

Abstract

The detection rate of intracranial aneurysms has increased with the improved availability of non-invasive imaging methods. Moreover, persons who have relatives with intracranial aneurysms increasingly demand imaging to rule out aneurysms. To deal with these problems, radiologists require basic knowledge regarding the detection and treatment of unruptured intracranial aneurysms. The prevalence of aneurysms in the normal population is 2 – 3 %. It increases to 4 – 10 % in persons with one relative with an aneurysm and to about 20 % in persons with two relatives with an aneurysm. The average natural rupture risk is estimated to be 5 % within 5 years of detection. In the individual case it depends on several variables that are discussed here. According to the literature, the risk of endovascular aneurysm treatment is about 5 %. On the basis of these data, the benefit of MRA screening needs to be discussed individually with the patient.

Key words

CNS - arteries - aneurysm - cerebral angiography - MR angiography - treatment effects

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