الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Nontraumatic subarachnoid hemorrhage is a neurologic emergency characterized by the extravasation of blood into the spaces covering the central nervous system that are filled with cerebrospinal fluid. The leading cause of nontraumatic subarachnoid hemorrhage is rupture of an intracranial aneurysm, which accounts for about 80 percent of cases and has a high rate of death and complications. The disorder is also associated with a substantial burden on health care resources, most of which are related to hospitalization. Subarachnoid hemorrhage has distinct demographic characteristics, risk factors, and treatments. It accounts for 2 to 5 percent of all new strokes. The incidence of the disorder has remained stable over the past 30 years, and although it varies from region to region, the aggregated worldwide incidence is about 10.5 cases per 100,000 person-years. Aneurysms presenting with subarachnoid hemorrhage tend to bleed again. Approximately 15 to 20 percent bleed a second time within the first two weeks. Persons with intracranial aneurysms presenting with symptoms of compression such as cranial-nerve palsies or brain-stem dysfunction should be evaluated and treated promptly because of the increased risk of rupture (6 percent per year) in this subgroup. The risk of rupture of an intracranial aneurysm that has not bled but is found incidentally is much less certain, and these intracranial aneurysms are generally managed electively. The three methods of choice to identify or rule out an intracranial aneurysm and to delineate the size and morphologic features of an intracranial aneurysm are CT Angiography (CTA) after a venous injection, magnetic resonance angiography (MRA), and angiography bydirect intra-arterial catheterization (catheter angiography); the last is still considered the benchmark. Several studies have evaluated the accuracy of detecting intracranial aneurysms by comparing CTA, MRA, and the synergistic combination of CTA and MRA with catheter angiography, intraoperative findings, or both. There are three options for treating intracranial aneurysms: observation, craniotomy with clip ligation, and endovascular occlusion with the use of detachable coils (coiling). Coil embolization may more successfully induce flow stagnation and promote thrombus formation in tightly packed aneurysms than in partially occluded ones, because blood flow renders partial occluded aneurysms “unstable” for thrombosis (Grunwald et al, 2007). For aneurysms that are not tightly packed, GDCs are exposed to the “water hammer effect,” which is responsible for aneurysmal regrowth (Li et al, 2006). Advances in microcatheter technology, endovascular techniques, and embolization materials have increased the popularity of neurointerventional therapy for aneurysms.The major advantage of endovascular occlusion of cerebral aneurysms is that it is less invasive (Jin et al, 2009). This study reviews the current knowledge of the developmental and microsurgical anatomy, pathogenesis, clinical features, diagnostic evaluation and endovascular treatment of intracranial aneurysms. This study included 20 patients with 20 intracranial aneurysms treated with endovascular occlusion. 16 aneurysms were coiled while 3 were treated by stent assisted coiling and one by ballon assisted coiling.The age of the patients ranged from 18 to 70 years with a mean age of 45 years, 11 patients were male, and 9 patients were female. Angiographic follow-up performed 3 and 6 months after endovascular treatment. The follow-up periods after endovascular treatment ranged from 3 to 6 months .The patients were clinically assessed using the Glasgow Outcome Scale (GOS) before and after the procedure and followed up every 3–6 months after discharge from the hospital. During the follow-up periods, 6 (30%) of the 20 aneurysms demonstrated various degrees of recanalization. There were 5 aneurysms with neck remnants and 1 with body remnants. Anatomic and procedural features were statistically analyzed to depict the most important factors affecting recanalization. Recanalization rates were not statistically different in ruptured and unruptured groups. The recanalization rate was significantly higher in large aneurysms than in small aneurysms. There was a trend toward higher recanalization rate in wide neck aneurysms than narrow neck, but this was not statistically significant. Aneurysms of the basilar artery or the internal carotid artery bifurcation are known to be more prone to arterial flow stresses than aneurysms of the middle cerebral artery or the anterior communicating artery. It is generally considered that this phenomenon induces more frequent recanalization. In our study, aneurysm located at the MCA showed higher recanalization rate .On the other hand, there was high recurrences rate in the aneurysms treated by stent-assisted coiling than with coils only. At the latest clinical evaluation, 5 of the 20 patients showed good recovery .11 had moderate disability , and 4 had severe disability .Among 13 patients who presented with acute SAH, 2 patients showed good recovery and 8 patients had moderate disabilities and 3 patients with severe disability. Of the 7 patients who had an unruptured aneurysm, 3 had good recovery, 3 had moderate disability and 1 had sever disability. Procedure related complications occurred in 2 of 20 patients, including 2 thromboembolic events, 0 intraprocedural aneurysm perforation. In spite of relatively high recanalization rate, complete endovascular occlusion of intracranial aneurysm is an effective technique in preventing aneurysmal bleeding with low morbidity and mortality rate.