Traumatic Intracranial Aneurysm Formation Following Closed Head Injury

Abstract

To the Editor: Thank you for taking the initiative to publish
the Journal of Vascular and Interventional Neurology. In reference to the publication by Miley et al., I have the following questions: What is the incidence of traumatic intracranial
aneurysm formation following closed head injury? Are there
differences in the approach to repair pseudoaneurysms? i.e,
repair the adventitia first, and the intima, internal elastic
lamina and media layers may auto-repair instead of what is
customarily done for true aneurysms where the rupture/lesion starts internally and the adventitia is usually spared until
late in the course.
P. Edwards-Conrad

Reply from the Authors: Thank you for your letter. The incidence of intracranial aneurysm formation after closed head
injury is limited but reported reported to be less than 1%.1-3
This number is greater (3.2%-12%) when associated with
penetrating injuries. You mention an interesting concept of
a differential treatment approach to pseudoaneurysms versus non-traumatic spontaneous aneurysms. Since the initial
mechanism of injury and the underlying changes in the arterial wall are considered being different, it is quite likely that the
vascular response mechanism and repair is different. Spontaneous non traumatic aneurysms are evolve, grow and eventually rupture in a chronic time frame, but when compared
to traumatic intracranial aneurysms these develop, grow and
eventually rupture during the acute or subacute period following the initial injury.4-8 However, these differences have
not been used practically to develop a different treatment approach from the classical approach to spontaneous intracranial aneurysms