Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Introduction: Comparative outcomes for unruptured aneurysms remain elusive due to the “moving target” of improved technology and treatment. Herein, outcomes in unruptured intracranial aneurysms (UIAs) in a single high-volume institution is analyzed and factors for poor neurological outcomes is reported.
Methods: All patients treated at a large quaternary center for an UIA from 1/1/2014 to 12/31/2020 were retrospectively reviewed. Inclusion criteria included an admission modified Rankin Scale (mRS) of 2. Optimal cutoff points for continuous variables were determined using Euclidean distance analysis. A p-inclusion multivariate model was used for analysis.
Results: During the 7-year study period a total of 425 patients were treated microsurgically. The mean PHASES score was 4.6 (sD 2.7), 90% (N=388) were saccular, 18% (N=77) were in the posterior circulation, 2.8% (N=12) underwent a bypass, and the mean maximum diameter and height were 6.1 mm (sD 3.3) and 5.5 mm (sD 3.3), respectively. A total of 38 (9.7%) were found to have a mRS > 2 on one-year follow-up. On univariate analysis, significant risk factors for a mRS >2 included diabetes, tobacco use, hyperlipidemia, hypertension, high ASA grade, age ≥ 61, Charlson Comorbidity Index ≥ 4, aspect ratio>1.68, size ratio >2.02, perpendicular height >2.95 mm, and PHASES >6. No tobacco use history (OR 4.35, 95% CI 1.72-12.5), p=0.003), diabetes (OR 3.09, 95% CI 1.00-0.29, p=0.045), hyperlipidemia (OR 4.33, 95% CI 1.33-14.0, p=0.013), and PHASES > 6 (OR 3.92, 95% CI 1.30-12.7, p=0.018) to be predictors of a poor neurological outcome at 1-year follow-up. One (0.18%) aneurysm required retreatment and 12 residuals (2.5%) were noted on follow-up with no SAH post-treatment.
Conclusion : Microsurgical treatment of UIAs is associated with low rates of residuals, retreatments, and poor neurological outcomes. Risk factors for a poor neurological outcome include diabetes, hyperlipidemia, a high PHASES score, and no history of tobacco use.
