+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

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



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



Acta Neurochirurgica 155(6): 1095



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. 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. 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). 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.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 036837882

Download citation: RISBibTeXText

PMID: 23558724

DOI: 10.1007/s00701-013-1688-y


Related references

Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. International Study of Unruptured Intracranial Aneurysms Investigators. New England Journal of Medicine 339(24): 1725-1733, 1998

Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms. Journal of Neurosurgery 119(1): 190-197, 2013

Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location. Journal of Neurosurgery 117(1): 60-64, 2012

Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms. Annals of Internal Medicine 168(2): 159, 2018

Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms. Annals of Internal Medicine 168(2): 159, 2018

Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review. Annals of Internal Medicine 167(1): 26-33, 2017

Unruptured Intracranial Aneurysms. A Critical Review of the International Study of Unruptured Intracranial Aneurysms (ISUIA) and of Appropriate Methods to Address the Clinical Problem. Interventional Neuroradiology 14(1): 85-96, 2008

Association of polymorphisms in the elastin gene with sporadic ruptured intracranial aneurysms and unruptured intracranial aneurysms in Chinese patients. International Journal of Neuroscience 123(7): 454-458, 2013

Patients with small, asymptomatic, unruptured intracranial aneurysms and no history of subarachnoid hemorrhage should be treated conservatively: against. Stroke 36(2): 410-411, 2005

Patients with small, asymptomatic, unruptured intracranial aneurysms and no history of subarachnoid hemorrhage should be treated conservatively. Stroke 36(2): 407, 2005

China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms. Journal of Translational Medicine 16(1): 263, 2018

Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke 38(4): 1404-1410, 2007

Unruptured intracranial aneurysms: natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clinics of North America 16(3): 383-90 Vii, 2006

Patients with unruptured intracranial aneurysms at the waiting list for intervention: risk of rupture. Journal of Neurology 261(3): 575-578, 2014

Unruptured cerebral aneurysms. What is the risk of rupture? What is the risk connected with a surgical intervention? A contribution to the international ISUIA study: International Study on Unruptured Intracranial Aneurysms. Recenti Progressi in Medicina 90(5): 249-253, 1999