Radiological surveillance of untreated unruptured intracranial aneurysms: A single surgeon's experience.

Radiological surveillance of untreated unruptured intracranial aneurysms: A single surgeon's experience.

World Neurosurg. 2016 Feb 24;

Authors: Teo M, St George EJ

Abstract
BACKGROUND: The management of untreated unruptured intracranial aneurysms remains controversial, the natural history is still not well understood and many patients are not routinely followed up. We present a single surgeon's data on radiological surveillance of these lesions.
METHODS: 94 patients with 152 unruptured intracranial aneurysms, with a mean follow up time of 3.4years from the time of diagnosis, underwent surveillance using CTA, MRA or DSA. Aneurysm growth was defined as an increase in one or more dimensions above the measurement error. Statistical analysis was performed.
RESULTS: Of 152 aneurysms, 126 (83%) were less than 7mm, 25 (16%) were 7-12mm and 1 aneurysm was 13-24mm. 18 of 152 (12%) cerebral aneurysms in 17 patients grew larger. 7% (9/126) of aneurysm <7mm, and 36% (9/25) of aneurysm 7-12mm enlarged. Spontaneous aneurysmal rupture occurred in 4 of 152 (2.6%) of aneurysms, ie 4/94 patients (4%), with an average initial aneurysm size of 5.7mm. The risk of aneurysm rupture per patient-year was 5% with growth, 0.2% without growth and there was a 24-fold increase in aneurysmal rupture risk for growing aneurysm (p=0.005). 15% (16/109) of aneurysms in group 1(no previous SAH), compared to 5% (2/43) of group 2 (previous SAH) aneurysms showed evidence of growth during the study period (p=0.0424).
CONCLUSIONS: These results support imaging follow up of patients with untreated unruptured intracranial aneurysms, including those with aneurysms smaller than the current treatment threshold of 7mm. Apart from the initial size, aneurysm growth is also associated with an increased risk of SAH and therefore growing aneurysms warrant treatment. The data also demonstrated that incidental aneurysms, in patients without previous SAH, do not behave less aggressively, contrary to current opinion.

PMID: 26921702 [PubMed - as supplied by publisher]

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