Size and Location of Ruptured Intracranial Aneurysms: A 5 Year Clinical Survey.

Size and Location of Ruptured Intracranial Aneurysms: A 5 Year Clinical Survey.

World Neurosurg. 2016 Apr 20;

Authors: Froelich JJ, Neilson S, Peters-Wilke J, Dubey A, Thani N, Erasmus A, Carr MW, Hunn AW

Abstract
BACKGROUND: Prospective international cohort trials have suggested that incidental cerebral aneurysms with diameters less than 10 mm are unlikely to rupture. Consequently small ruptured cerebral aneurysms should rarely be seen in clinical practice. To verify this theory, dimensions and locations of ruptured cerebral aneurysms were analyzed across the state of Tasmania, Australia.
METHODS: We retrospectively reviewed medical records and diagnostic tests of all patients admitted with ruptured cerebral aneurysms over a 5 year interval. Aneurysm location, maximum size, dome to neck ratio, volume and presence of daughter sacs were determined by preoperative digital subtraction angiography or computed tomography angiography.
RESULTS: 131 ruptured cerebral aneurysms were encountered and treated by microsurgical clipping (n=59) or endovascular techniques (n=72). The mean maximum aneurysm diameter was 6.4 ± 3.7 mm, DNR 2 ± 0.8, aneurysm volume 156 ± 372 mm(3) and daughter sacs were present in 70 aneurysms (53.4 percent). The anterior communicating artery was the most common location (37.4 percent). Cumulative maximum diameters of ruptured aneurysms were ≤ 5 mm in 49 percent, ≤ 7 mm in 73 percent, and ≤ 10 mm in 90 percent.
CONCLUSIONS: Despite findings from prospective international cohort trials, small ruptured intracranial aneurysms are common in clinical practice. In consequence, it seems important to identify those patients with small but vulnerable unruptured aneurysms before conservative management is considered.

PMID: 27108026 [PubMed - as supplied by publisher]

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