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Estimated low risk of rupture of small-sized unruptured intracranial aneurysms (UIAs) in relation to intracranial aneurysms in patients with subarachnoid haemorrhage

  • Clinical Article - Vascular
  • Published:
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Abstract

Objective

International guidelines for the management of unruptured intracranial aneurysms (UIAs) recommend observation in aneurysms <10 mm due to the estimated low risk of rupture. The aim of our study was analyse the data of recently treated patients with ruptured cerebral aneurysms with the special focus on size and configuration in view of the frequency scale in a daily routine setting.

Methods

We reviewed the data of all patients with aneurysmal subarachnoid haemorrhage (SAH) during the last 24 months at our institution. Configuration and size of the aneurysms were measured. Clinical data were collected using the following classifications for analysis: Hunt and Hess (H&H), modified Rankin Scale (mRS) and Fisher classification.

Results

Data of 135 patients with aneurysmal SAH (98 women, 37 men; ratio 2.6:1) were analysed. Analysis showed that 19 aneurysms (14 %) were >10 mm (mean size, 19.2 mm) and 116 aneurysms (85.9 %) <10 mm (mean size, 6.2 mm). In total, 112 were categorised as berry-like configured aneurysms (n = 113 <10 mm, n = 3 >10 mm), 18 as multi-lobar (n = 16 <10 mm, n = 2 >10 mm) and 5 as fusiform (n = 4 <10 mm, n = 1, >10 mm).

Conclusion

Since the results of our study showed that the majority of the aneurysms are <10 mm (mean, 6.2 mm), it is justified to challenge the recommendations of the international guidelines in a daily routine setting. We believe that the published data are not convincing enough to play a guidance role in daily routine. Due to improving surgical and endovascular techniques with satisfying results and the high number of ruptured small aneurysms, we believe a change in attitude in management of small-sized aneurysms is needed. Further diagnostic models are needed to determine the risk of rupture of intracranial aneurysms properly to obtain adequate treatment for UIAs.

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Authors and Affiliations

  1. Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Zu den Rehwiesen 9-11, 47055, Duisburg, Germany

    Homajoun Maslehaty, Hannah Ngando, Martin Scholz & Athanasios K. Petridis

  2. Department of Radiology and Neuroradiology, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Duisburg, Germany

    Dan Meila & Friedhelm Brassel

Authors
  1. Homajoun Maslehaty
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  2. Hannah Ngando
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  3. Dan Meila
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  4. Friedhelm Brassel
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  5. Martin Scholz
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  6. Athanasios K. Petridis
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Corresponding author

Correspondence to Homajoun Maslehaty.

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Comment

This important paper addresses well the controversy between the ISUIA recommendations followed by many, if not most, and daily clinical practice where most of the ruptured aneurysms are small in size. We analysed a series of 3,000 patients with ruptured aneurysms treated during the last 20 years, and in 66 % the size was smaller than 10 mm and, notably, in 14 % smaller than 5 mm. As the incidence of SAH in Finland (and Japan) for undefined reasons is 2–3 times higher than elsewhere, and people are living longer and healthier lives, we recommend unruptured aneurysms ≥3 mm to be treated in patients up to 70 years of age. Cessation of smoking and active treatment of hypertension is pertinent in all age groups.

Hanna Lehto

Mika Niemelä

Helsinki, Finland

H. Maslehaty and H. Ngando contributed equally to this study

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Maslehaty, H., Ngando, H., Meila, D. et al. Estimated low risk of rupture of small-sized unruptured intracranial aneurysms (UIAs) in relation to intracranial aneurysms in patients with subarachnoid haemorrhage. Acta Neurochir 155, 1095–1100 (2013). https://doi.org/10.1007/s00701-013-1688-y

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  • DOI: https://doi.org/10.1007/s00701-013-1688-y

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