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Review
. 2016 Sep 15;56(9):552-68.
doi: 10.2176/nmc.st.2016-0063. Epub 2016 Apr 6.

Preemptive Medicine for Cerebral Aneurysms

Tomohiro Aoki  1 , Kazuhiko Nozaki
Affiliations
Review

Preemptive Medicine for Cerebral Aneurysms

Tomohiro Aoki et al. Neurol Med Chir (Tokyo). .

Abstract

Most of cerebral aneurysms (CAs) are incidentally discovered without any neurological symptoms and the risk of rupture of CAs is relatively higher in Japanese population. The goal of treatments for patients with CAs is complete exclusion of the aneurysmal rupture risk for their lives. Since two currently available major treatments, microsurgical clipping and endovascular coiling, have inherent incompleteness to achieve cure of CAs with some considerable treatment risks, and there is no effective surgical or medical intervention to inhibit the formation of CAs in patients with ruptured and unruptured CAs, new treatment strategies with lower risk and higher efficacy should be developed to prevent the formation, growth, and rupture of CAs. Preemptive medicine for CAs should be designed to prevent or delay the onset of symptoms from CAs found in an asymptomatic state or inhibit the de novo formation of CAs, but we have no definite methods to distinguish rupture-prone aneurysms from rupture-resistant ones. Recent advancements in the research of CAs have provided us with some clues, and one of the new treatment strategies for CAs will be developed based on the findings that several inflammatory pathways may be involved in the formation, growth, and rupture of CAs. Preemptive medicine for CAs will be established with specific biomarkers and imaging modalities which can sensor the development of CAs.

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Conflict of interest statement

The authors, who are members of the Japan Neurosurgical Society, have registered the online Self-reported COI Disclosure Statement Forms. T. A. is supported by the coordination fund from Japan Science and Technology Agency (JST) and Astellas Pharma Inc., Tokyo, Japan. K. N. has no conflicts of interest.

Figures

Fig. 1
Fig. 1. Idea of preemptive medicine
Fig. 2
Fig. 2. Inflammatory process in the development of cerebral aneurysms. COX-2: cyclooxygenase-2, EP2: prostaglandin E2 receptor 2, MCP-1: monocyte chemotactic protein-1, NF-kB: nuclear factor-kappa B, PGE2; prostaglandin E2, TNF-α: tumor necrosis factor-α
Fig. 3
Fig. 3. Cerebral aneurysm development and preemptive medicine
See this image and copyright information in PMC

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