Radiation-associated intracranial aneurysms: A systematic review of clinical presentation,morphology,and treatment outcomes

Abstract

Background

Radiation-associated intracranial aneurysms (RAIs) are a rare but increasingly recognized late complication of cranial and cervical radiotherapy, particularly among long-term survivors of head and neck tumors. This study aims to provide a comprehensive review of the clinical, anatomical, and therapeutic characteristics of RAIs.

Methods

We conducted a systematic review of published RAI cases (1984–2024), collecting data on patient demographics, oncologic history, aneurysm morphology and location, latency from radiotherapy, clinical presentation, and treatment outcomes. The review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results

A total of 103 patients with 142 intracranial aneurysms were included. The mean latency between radiotherapy and aneurysm diagnosis was 11.3 years (range: 2–21 years). The mean age at radiotherapy was 36.7 years (range: 4 months to 79 years), and the mean age at aneurysm diagnosis was 47.8 years (range: 6–90 years). Aneurysms were most commonly located in the internal carotid artery (32%) and posterior circulation (23%). Morphologically, 45.1% were dissecting or nonsaccular. Half of the aneurysms presented with subarachnoid hemorrhage. Approximately 65% underwent treatment, with about two-thirds managed via endovascular approaches—primarily coiling and stent-assisted coiling. Adequate occlusion was achieved in 66% of aneurysms overall, with an even higher rate of complete/near-complete occlusion—73.1%—among endovascularly treated aneurysms, compared to 48.5% for those treated surgically. The mean radiological follow-up period was 19.5 months.

Conclusion

Radiation-associated intracranial aneurysms are rare vascular lesions with distinct anatomical and clinical features. Early recognition and sustained long-term monitoring are crucial to enable timely intervention. Further research is needed to establish evidence-based strategies for screening and managing this high-risk population.