%0 Journal Article
%T Understanding the Role of Hemodynamics in the Initiation, Progression, Rupture, and Treatment Outcome of Cerebral Aneurysm from Medical Image-Based Computational Studies
%A Marcelo A. Castro
%J ISRN Radiology
%D 2013
%R 10.5402/2013/602707
%X About a decade ago, the first image-based computational hemodynamic studies of cerebral aneurysms were presented. Their potential for clinical applications was the result of a right combination of medical image processing, vascular reconstruction, and grid generation techniques used to reconstruct personalized domains for computational fluid and solid dynamics solvers and data analysis and visualization techniques. A considerable number of studies have captivated the attention of clinicians, neurosurgeons, and neuroradiologists, who realized the ability of those tools to help in understanding the role played by hemodynamics in the natural history and management of intracranial aneurysms. This paper intends to summarize the most relevant results in the field reported during the last years. 1. Introduction Stroke is the leading cause of long-term disability and the third cause of death in the Western World. Subarachnoid hemorrhage (SAH) is one of the most severe types of stroke, which usually occurs when an intracranial aneurysm ruptures [1]. SAH refers to a leakage of blood into the subarachnoid spaces, which is a continuous space between the supratentorial and infratentorial compartments. A greater concentration of the blood products around the site of bleed is usual. When hemorrhage extends into the adjacent parenchymal structures and ventricular system, it results in a higher morbidity and mortality rate [2]. Vasospasm, in which blood vessels constrict to restrict blood flow, is a serious consequence of SAH because it may cause ischemic brain injury and permanent brain damage due to lack of oxygen in parts of the brain [3]. Understanding of the underlying mechanisms that result in injury after SAH is limited. However, a number of studies indicate that apoptosis may play a major role in the pathogenesis of secondary brain injury after SAH [4]. Elevated intracranial pressure is an important consequence of aneurysmal SAH that often results in not only decreased cerebral perfusion but also secondary clinical decline [5]. Intracranial aneurysms tend to initiate at or near arterial bifurcations, mostly in the circle of Willis. The yearly risk of subarachnoid hemorrhage for an unruptured intracranial aneurysm is approximately 1% for lesions 7 to 10£żmm in diameter. The optimal management of unruptured aneurysms is controversial, and current decision making is mainly based on aneurysm size and location, as derived from the International Study of Unruptured Intracranial Aneurysms (ISUIA) [6]. Current guidelines suggest that, with rare exceptions, all
%U http://www.hindawi.com/journals/isrn.radiology/2013/602707/