Traumatic intracranial aneurysms: A contemporary review in the endovascular era

Abstract

Introduction

Traumatic intracranial aneurysms (TICAs) are rare, potentially fatal complications of traumatic brain injury (TBI) or iatrogenic insult. Often forming as pseudoaneurysms, TICAs result from direct arterial wall disruption. Their unique pathophysiology, delayed presentation, and high rupture risk pose diagnostic and therapeutic challenges. This review synthesizes current evidence on TICA pathogenesis, diagnosis, and treatment, with particular emphasis on the evolving role of angiographic diagnosis and endovascular intervention.

Methods

A structured PubMed search was conducted, supplemented by manual citation screening. All study designs were considered with no date restrictions. Articles were included if they reported traumatic intracranial aneurysms in patients of any age and discussed diagnostic or therapeutic approaches. Data were synthesized thematically across epidemiology, pathophysiology, imaging, treatment (endovascular and surgical), and surveillance.

Results

TICAs typically arise at sites of direct injury or at fixed vessel segments (e.g., distal ACA, peripheral MCA, cavernous/supraclinoid ICA). Their delayed and subtle appearance necessitates high clinical suspicion and serial imaging. Digital subtraction angiography is the diagnostic gold standard, though immediate or early post-trauma studies may be negative. Endovascular techniques, particularly flow diversion, are increasingly favored for their minimally invasive nature and ability to achieve parent vessel reconstruction. Open surgery retains a role for lesions complicated by mass effect, intracerebral hematoma, or anatomy unsuitable for endovascular repair. Outcomes vary with aneurysm location, treatment timing, modality, and TBI severity.

Conclusion

TICAs represent a distinct, high-risk entity requiring timely diagnosis and individualized, multidisciplinary management. Endovascular approaches are increasingly favored. Further research is needed to guide optimal surveillance imaging protocols.