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ROLLING MEADOWS
Neurosurgeons have revealed that cigarette smoking is
a significant risk factor for aneurysm rupture. In a study, "Natural History of
Enraptured Intracranial Aneurysms: Probability of and Risk Factors for
Aneurysm Rupture," published in the September issue of the Journal of
Neurosurgery (scientific publication of the American Association of
Neurological Surgeons), neurosurgeons investigated the long-term natural
history of Enraptured intracranial aneurysms, finding a significant association
between cigarette smoking and increased size of an Enraptured lesion and
subsequent aneurysm rupture. Authors of the study included Seppo Juvela, MD,
PhD, Matti Porras, MD, PhD and Kristina Poussa, MD from Helsinki, Finland.
Intracranial aneurysm rupture is a catastrophic event. Each year approximately
30,000 people suffer intracranial aneurysm rupture in the United States; 60%
die or are disabled.
In addition, approximately half the patients who survive are unable to return
to their previous employment or suffer from significant neuropsychological and
cognitive deficits. A variety of non-invasive imaging techniques, particularly
MRI (magnetic resonance imaging) and MRA (magnetic resonance angiography), now
allow physicians to detect even small intracranial aneurysms in otherwise
healthy individuals. In view of this, neurosurgeons have attempted to identify
and repair intracranial aneurysms before they rupture. This strategy, however,
is associated with a small risk to the patient. Consequently there is debate
among medical professionals about which patients should undergo repair of
Enraptured intracranial aneurysms. In addition, it is not clearly known which
people are at highest risk for intracranial aneurysm rupture and so should
undergo imaging studies to detect these lesions before they become symptomatic.
Intracranial aneurysms are thought to be acquired degenerative lesions that
form because of homodynamic stress from circulating blood, or in a few
patients, because of connective tissue diseases.
Several studies have shown that larger aneurysms are more likely to rupture.
The study by Juvela and colleagues now demonstrates that a modifiable risk
factor, cigarette smoking, is significantly associated with aneurysm rupture.
This information assists in determining which patients should undergo repair of
Enraptured aneurysms. In the study, 142 patients with a total of 181 Enraptured
aneurysms who did not undergo treatment of these lesions were followed from
1956 until 1998 or until death or aneurysm rupture. These patients or their
relatives were all interviewed in the outpatient department of the Department
of Neurosurgery at Helsinki University Central Hospital, in Helsinki, Finland
using a structured questionnaire that included data on height and weight;
previous diseases; hospital visits; regular drug use; including analgesic
medications, stimulants, and narcotics; approximate intake of coffee, beer,
wine and spirits; current and previous smoking status; and family history of
intracranial aneurysms.
During these 2,575 cumulative-years of patient follow up, there were 33 first
time episodes of intracranial aneurysm rupture. Seventeen of these patients
died; most from the brain damage from a severe initial hemorrhage. The authors
found that three factors: increased aneurysm size, patient age and cigarette
smoking were independent predictors for aneurysm rupture "The significant
association between cigarette smoking and the risk of subsequent rupture of the
intact aneurysm strongly suggests that smoking increases the size of an
Enraptured lesion," said Seppo Juvelo, MD, PhD, a practicing neurosurgeon and
member of the American Association of Neurological Surgeons (AANS). "We know
that smoking constricts blood vessels, but whether it can cause formation of a
new aneurysm remains unknown." The results of this study, however, suggest that
Enraptured intracranial aneurysms should be treated, provided patient age and
the presence of pre-existing diseases do not increase treatment risk.
In particular the authors noted that the younger patients and those who smoke
should undergo aneurysm treatment by a neurosurgeon. Among those patients who
cannot undergo surgery because of medical risk factors, the option to quit
smoking is a good alternative to surgery. The Journal of Neurosurgery is the
scientific publication of the American Association of Neurological Surgeons.
Founded in 1931 as the Harvey Cushing Society, the American Association of
Neurological Surgeons is a scientific and educational association with nearly
5,800 members worldwide. The AANS is dedicated to advancing the specialty of
neurological surgery in order to provide the highest quality of neurosurgical
care to the public. All active members of the AANS are Board-certified by the
American Board of Neurological Surgery. Neurological surgery is the medical
specialty concerned with the prevention, diagnosis, treatment and
rehabilitation of disorders that affect the spinal column, spinal cord, brain,
nervous system and peripheral nerves.
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