Aneurysm Wall Histology and
Correlation with Cerebrospinal Fluid and
Blood Plasma - Registry
Ruptured Cerebral Aneurysms are the leading cause of subarachnoid hemorrhage, with the average size being 5-8mm in size. Aneurysms larger then 10mm have a totally different disease process within the wall and potentially less understood. This cohort of aneurysms usually does not rupture and they have been reported to grow within the subarachnoid space conforming to its surroundings.
Endovascular coiling has been shown, over the last decade, to be a definitive alternative to open surgical clipping. However, with the development of newer second generation coils as well as some reports of platinum coils, there has been an increase in post embolic complications. These complications have included but not limited to inflammation, meningitis, ventricular enlargement and in some cases symptomatic hydrocephalus. This phenomenon has also elicited some changes within the cerebrospinal fluid-CSF in the symptomatic patients. Some reports have indicated an elevation of proteins with increased cytokine expression within the CSF.
This post embolic syndrome has not been seen in all aneurysm groups or all patient groups but is of significant interest to identify predictors as to why they occur. If predictors can be clearly identified, then pre, intra or post treatment regiments can be altered to prevent the onset.
This research registry will gather aneurysm wall biopsies during open surgical clipping of any unruptured intracranial aneurysm as well as sampling of the CSF from within the open cisterns of the same target patient. The samples will be evaluated and correlated for any type of abnormalities within the wall and CSF.
To design a registry to evaluate the wall of intracranial aneurysms during open surgical clipping by direct photographic appearance, wall biopsy samples, CSF and blood plasma fluid collection (IL-6, IL-8 MMP-9) for complete evaluation and comparison.
The focus of the registry will be to determine the presences of aneurysmal wall defects, mural clot, atherosclerotic and atheroma, wall permeability and delamination. These findings will then be correlated to the collected CSF and blood values to determine if there is any direct features of the aneurysm wall that would predict any of the reported post embolic syndromes. The collected data can also be correlated to the preoperative imaging, (MRI, CT and Angiogram).
The registry will be a multi-center registry which will be designed, initiated and run by Dr. Raymond Turner of the Medical University of South Carolina as the Primary Investigator. It will consist of 50 patients who present with unruptured intracranial aneurysms >8mm. Any patient can be a potential candidate for the registry and will undergo preoperative imaging to determine if there are any preexisting lesions that would preclude the patient from being enrolled. The patient will then undergo an open surgical biopsy and clipping of the target aneurysm, withdrawal of a predetermined amount of CSF from the cisterns and blood which will all be evaluated.