Surgical treatment of asymptomatic and incidental intracranial aneurysms

Salazar, Jose L.

doi:10.3171/jns.1980.53.1.0020

Cited by 90 publications

(17 citation statements)

References 5 publications

(1 reference statement)

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“…Some advocating operation for all intracranial aneurysms [4,6,19,20,27,30,33], others believing that the unruptured aneurysms could be left alone [17,22,25,26], and others suggesting that the asymptomatic aneurysm should be treated at the same setting as a symptomatic aneurysm, if possible, but not by separate operation [3]. The problem is that, the natural history of haemorrhage from previously unruptured aneurysm is an unknown factor.…”

Section: Introductionmentioning

confidence: 99%

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Surgical outcome for multiple intracranial aneurysms

et al. 1996

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The surgical outcome of 221 cases with multiple intracranial aneurysms operated upon during the years 1988 to 1994 were reviewed. The patients were classified into three groups according to the locations of the aneurysms; group 1: multiple aneurysms located unilaterally in the anterior circulation only (147 cases); group 2: multiple aneurysms located bilaterally in the anterior circulation only (44 cases) and group 3: multiple aneurysms located in both anterior and posterior circulation or in the posterior circulation alone (30 cases). In 132 cases of group 1 (89.8%) all aneurysms were treated in one-stage operations. Twenty-eight patients from group 2 (63.6%) received partial treatment, where only the ruptured or the symptomatic aneurysms were treated. In 12 other cases from group 2 (27.3%) all multiple aneurysms were treated in two-stage operations. In group 3 patients, one-stage operations were performed in 18 cases (60%), while 9 patients (30%) received partial treatment only. Of the 221 multiple aneurysm cases, 162 (73.3%) presented with manifestations of subarachnoid haemorrhage (SAH). The remaining 59 multiple aneurysms cases (26.7%) presented with manifestations other than SAH (unruptured aneurysms). In the postoperative follow-up, of the 221 multiple aneurysms cases, 113 (51.1%) were free of neurological deficit (excellent), 48 cases (21.7%) were capable of leading an independent life (good), 32 cases (14.5%) were not independent and needed to be assisted (fair), and 28 patients (12.7%) died. These results were comparable to the results of patients with single aneurysms operated on during the same period. Based on our results, we recommend that whenever possible all multiple aneurysms should be treated in one-stage operations. In unruptured multiple aneurysm cases surgical management is the recommended treatment. In poor grade SAH patients or unruptured multiple aneurysms in old patients, two-stage operations or partial treatment of only the ruptured or the symptomatic aneurysms may be adopted.

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Section: Introductionmentioning

confidence: 99%

“…It is generally agreed that all aneurysms that can be reached using a single surgical approach should be dealt with if technically possible, whereas, when that is impossible the asymptomatic aneurysms should be dealt with at a second operation [4,8,30,32].…”

Section: Introductionmentioning

confidence: 99%

Surgical outcome for multiple intracranial aneurysms

et al. 1996

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“…The ISUIA has shown that the annual risk of rupture is approximately 1% only for aneurysms greater than or equal to 10 mm and that aneurysms less than 10 mm have a negligible risk of rupture (0.05%/year in Group 1 and 0.5%/year in Group 2 aneurysms). 13 In contrast, Rinkel, et al, 31 in their systematic review of all natural history studies conducted between 1955 and 1996, found that the overall annual rupture rate for UIAs is 1.9% (4%/year for aneurysms Ն 10 mm and 0.7%/year for aneurysms Ͻ 10 mm). 30 The discrepancy in the aneurysmal rupture rates between the systematic review and the ISUIA has been partly attributed to the shorter followup period of 8.3 years in the ISUIA compared with the 13.9-year period of Juvela, et al 15 Additional data from the prospective arm of the ISUIA should help resolve the above issue.…”

Section: Natural History Of Iiasmentioning

confidence: 99%

“…This is less than that reported in the ISUIA and compares favorably with the outcomes in previous studies. 10,20,22,25,26,31,32,43 In addition, half the patients with postprocedural neurological deficits at 30 days subsequently recovered to their functional baseline. Cognitive impairment as an independent factor was not significantly associated with postprocedural morbidity at 6 months.…”

Section: Treatment-related Risksmentioning

confidence: 99%

Identifying patients at risk for postprocedural morbidity after treatment of incidental intracranial aneurysms: the role of aneurysm size and location

Janardhan¹,

Friedlander²,

Riina³

et al. 2002

FOC

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Object A decision to treat incidental intracranial aneurysms (IIAs) relies on understanding the risks of treatment and weighing them against the those of aneurysm rupture. Whereas the natural history of IIAs is currently being studied, the risks associated with treating IIAs and factors associated with poor outcome need to be clearly established. Methods In a consecutive series of 125 patients, 160 IIAs were treated either surgically (152 cases) or endovascularly (eight cases). Postprocedural morbidity was defined as a new neurological deficit associated with a score greater than or equal to 3 on the modified Rankin Scale or a score of less than 24 on the Mini-Mental Status Examination. Logistic regression analysis was used to identify predictors of postprocedural morbidity from retrospectively collected data on demographic, clinical, and radiographic characteristics. Treatment of IIAs was not associated with any mortality and was associated with postprocedural morbidity in 17 (13.6%) of 125 patients (early outcome) and eight (6.4%) of patients (late outcome). In the logistic-regression model, treatment of aneurysms (≥13 mm) and posterior circulation aneurysms were independently associated with postprocedural morbidity. In patients in whom postprocedural neurological deficits developed, 12 (70.6%) of 17 and four (23.5%) of 17 patients harbored aneurysms with broad or calcified necks, respectively. Age, comorbidities, multiple aneurysms, specific aneurysm location, and history of subarachnoid hemorrhage related to a different aneurysm were not significantly associated with poor outcome. Conclusions The authors found that IIAs can be safely and effectively treated without causing mortality and with a lower morbidity rate than previously reported. A combination of radiographic variables may be helpful in identifying patients at risk for postprocedural morbidity.

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“…14 Screening followed by surgical repair of unruptured aneurysms has been introduced to reduce the number of patients developing SAH, and many neurosurgeons have reported reasonably good results in several series of patients. 9,10,13,[15][16][17][18][19][20] These authors all advocate surgical treatment, but do their results indicate that all asymptomatic, unruptured aneurysms should be repaired? If so, should wide-scale screening be implemented for asymptomatic populations?…”

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confidence: 99%

Cost-Effectiveness Analysis of Screening for Asymptomatic, Unruptured Intracranial Aneurysms

Yoshimoto

Wakai

1999

Stroke

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Background and Purpose-Subarachnoid hemorrhage (SAH) due to aneurysmal rupture is a major cause of cerebrovascular disease-related death. This problem could be eliminated by diagnosis and successful treatment of aneurysms before rupture. Recent developments in high-resolution imaging technology have made screening for unruptured aneurysms possible in the general population. Such screening has become widespread in Japan ("No Dokku," or brain checkup). As a result, unruptured aneurysms are being identified with increasing frequency. However, the economic implications of treatment decisions for unruptured aneurysms have not been analyzed. Therefore, we performed such an analysis. Methods-We used a Markov model to evaluate the cost-effectiveness of screening for asymptomatic, unruptured intracranial aneurysms. The model involved a set of variables describing discrete health states. Each state was assigned a quality of life score and an associated medical cost. A comparison of the expected outcomes was then made between 2 hypothetical cohorts, one receiving screening and the other no screening. A sensitivity analysis was performed by altering the input values within clinically reasonable ranges to reflect uncertainty in the baseline analysis and then assessing the effects on outcomes. Results-Combining the incremental cost and effectiveness data revealed a cost per quality-adjusted life-year of $7760 for an annual rate of subarachnoid hemorrhage due to unruptured aneurysms (rupture rate) of 0.02; this cost was $39 450 for a rupture rate of 0.01. There was no benefit (negative quality-adjusted life-year benefit) for a rupture rate of 0.005, the rupture rate found in a recently published international cooperative study. The risks of surgery for unruptured aneurysms and the discounting ratio used to assess the impact of timing of costs and benefits on future outcomes also had significant effects on the results. Other variables had little impact on cost-effectiveness. Conclusions-The cost-effectiveness of screening for an unruptured aneurysm is highly sensitive to the annual rate of subarachnoid hemorrhage due to unruptured aneurysms. The low annual rupture rate seen in the recent large international cooperative study implies that screening asymptomatic populations to identify and treat unruptured aneurysms would not be cost cost-effective. (Stroke. 1999;30:1621-1627.)

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Surgical treatment of asymptomatic and incidental intracranial aneurysms

Cited by 90 publications

References 5 publications

Surgical outcome for multiple intracranial aneurysms

Surgical outcome for multiple intracranial aneurysms

Identifying patients at risk for postprocedural morbidity after treatment of incidental intracranial aneurysms: the role of aneurysm size and location

Cost-Effectiveness Analysis of Screening for Asymptomatic, Unruptured Intracranial Aneurysms

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