Article
Analysis of size and configuration of ruptured aneurysms under consideration of international guidelines for management of un-ruptured intracranial aneurysms – Is observation justified?
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Authors
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Homajoun Maslehaty
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany
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Hannah Ngando
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany
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Athanasios Petridis
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany
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Martin Scholz
- Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany
| Published: | May 21, 2013 |
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Outline
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Objective: According to the international guidelines for management of un-ruptured intracranial aneurysms (UIA) asymptomatic and incidentally founded berry-like aneurysms < 1cm should be observed, due to the low annual risk of rupture. Treatment (clip occlusion or coil embolization) should be done in cases of growth. The aim of our study was analyze 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.
Method: We reviewed the data of all patients with aneurysmal SAH during the last 18 month at our institution. Configuration and size of the aneurysms were measured. Clinical data was collected using the following classifications for analysis: Hunt & Hess (HH), WFNS grade, modified Rankin Scale (mRS) and Fisher classification.
Results: We analyzed the data of n=135 patients with aneurysmal SAH (98 female, 37 male, ratio 2.6:1). Mean age was 56.9 years (range: 30-86 years). Analysis showed that n=19 aneurysms (14%) were >1cm (mean size: 1.92cm) and n=116 aneurysms (85.9%) <1cm (mean size: 0.62cm). In total, n=112 were categorized as berry like configured aneurysms (n=113 <1cm; n=3 >1cm), n=18 as multi-lobar (n=16 <1cm; n=2 >1cm) and n=5 as fusiform (n=1 >1cm). The distribution to the Hunt&Hess scale was as follows: HH 1 n=17, HH 2 n=27, HH 3 n=17, HH 4 n=17, HH 5 n=57. The outcome distribution according to mRS was: mRS 0 n=37, mRS 1 n=34, mRS 2 n=16, mRS 3 n=7, mRS 4 n=3, mRS 5 n=0, mRS 6 n=1.
Conclusions: Due to the rising number of performed neuro-imaging in line with diagnostic evaluation for various symptoms, UIAs are found increasingly. Hence, we are more and more faced with patients with UIAs, needing competent advice on this issue. Since the results of our study with ruptured aneurysms showed that the majority of the aneurysms are < 1cm (mean 0.62cm) it is justified to challenge the recommendations of international guidelines in a daily routine session. We believe that the published data is not convincing enough to play a guidance role in daily routine. Due to improving surgical and endovascular techniques with satisfying results, we recommend contemporary treatment even small sized aneurysms to prevent SAH.
