Endovaskuläre Behandlung von intrakraniellen Aneurysmen

Zusammenfassung

Ein intrakranielles Aneurysma ist die häufigste Ursache für eine spontane Subarachnoidalblutung. Eine dringliche Versorgungspflicht besteht bei akut rupturierten Aneurysmen zur Verhinderung einer häufig fatalen frühen Nachblutung. Auch bei inzidentellen Aneurysmen kann die Indikation zu einer prophylaktischen Versorgung bestehen, um eine mögliche zukünftige Ruptur zu verhindern. In vielen Fällen ist die endovaskuläre Therapie mit ablösbaren Platinspiralen (Coils) möglich. Verschiedene Techniken ermöglichen die endovaskuläre Behandlung von komplexen Aneurysmen. In randomisierten Studien zeigte die endovaskuläre Therapie eines akut rupturierten Aneurysmas eine signifikant geringere prozedurale Morbidität und Mortalität im Vergleich zur bis dahin vorrangigen Operation mit Clipping. Daher stellt die endovaskuläre Therapie heute die erste Behandlungsoption dar. Auch im langfristigen Verlauf bestätigten sich die Vorteile der endovaskulären Coilembolisation. Jedoch gibt es Aneurysmakonfigurationen, insbesondere mit Abgang von Gefäßästen aus dem Aneurysmalumen, die weiterhin vorwiegend neurochirurgisch behandelt werden sollten. Über die Therapie von intrakraniellen Aneurysmen sollte möglichst immer interdisziplinär von Neurochirurgien, Neurologen und interventionellen Neuroradiologen im Konsens entschieden werden.

Summary

Intracranial aneurysms are the major source of spontaneous subarachnoid hemorrhage. A mandatory indication for therapy is the acute rupture of an intracranial aneurysm to prevent often fatal early rebleeding. Incidental aneurysms also bear the danger of future rupture and treatment may be indicated. In the majority of cases, an endovascular treatment with detachable platinium coils is possible. With additional devices, complex wide neck aneurysms can be treated with endovascular techniques as well. Randomized studies revealed significantly less morbidity and mortality for the endovascular therapy compared to surgical clipping. Thus, the endovascular approach is the treatment modality of choice nowadays. Also, the long-term results favor the endovascular coilembolization of intracranial aneurysms. However, some aneurysmal configurations, in particular with branches arising from the aneurysmal lumen, are still reserved for neurosurgical therapy. In consequence, therapy and treatment of intracranial aneurysms should be performed from neurosurgeons, neurologists, and interventional neuroradiologists on an interdisciplinary consensus basis.

Schlüsselwörter

Endovaskulär - Behandlung - Aneurysma - intrakraniell

Keywords

Endovascular - treatment - aneurysm - intracranial

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