RT Journal Article
SR Electronic
T1 Unruptured intracranial aneurysm follow-up and treatment after morphological change is safe: observational study and systematic review
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 1277
OP 1282
DO 10.1136/jnnp-2016-313584
VO 87
IS 12
A1 Renato Gondar
A1 Oliver Pascal Gautschi
A1 Johanna Cuony
A1 Fabienne Perren
A1 Max Jägersberg
A1 Marco-Vincenzo Corniola
A1 Bawarjan Schatlo
A1 Granit Molliqaj
A1 Sandrine Morel
A1 Zsolt Kulcsár
A1 Vitor Mendes Pereira
A1 Daniel Rüfenacht
A1 Karl Schaller
A1 Philippe Bijlenga
YR 2016
UL http://jnnp.bmj.com/content/87/12/1277.abstract
AB Background The management of small unruptured incidentally discovered intracranial aneurysms (SUIAs) is still controversial. The aim of this study is to assess the safety of a management protocol of SUIAs, where selected cases with SUIAs are observed and secured only if signs of instability (growth) are documented.Methods A prospective consecutive cohort of 292 patients (2006–2014) and 368 SUIAs (anterior circulation aneurysms (ACs) smaller than 7 mm and posterior circulation aneurysms smaller than 4 mm without previous subarachnoid haemorrhage) was observed (mean follow-up time of 3.2 years and 1177.6 aneurysm years). Factors associated with aneurysm growth were systematically reviewed from the literature.Results The aneurysm growth probability was 2.6±0.1% per year. The rate of unexpected aneurysm rupture before treatment was 0.24% per year (95% CI 0.17% to 2.40%). The calculated rate of aneurysm rupture after growth was 6.3% per aneurysm-year (95% CI 1% to 22%). Aneurysms located in the posterior circulation and aneurysms with lobulation were more likely to grow. Females or patients suffering hypertension were more likely to have an aneurysm growing. The probability of aneurysms growth increased with the size of the dome and was proportional to the number of aneurysms diagnosed in a patient.Conclusions It is safe to observe patients diagnosed with SUIAs using periodic imaging. Intervention to secure the aneurysm should be performed after growth is observed.