gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Can treatment decision of unruptured intracranial aneurysms be based on PHASES score?

Meeting Abstract

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  • Renato Gondar - Division of Neurosurgery and
  • Johanna Cuony - Division of Neurosurgery and
  • Fabienne Perren - Division of Neurology, Geneva University Hospitals, Geneva Neurosciences Center, Faculty of Medicine, University of Geneva, Switzerland
  • Karl Schaller - Division of Neurosurgery and
  • Philippe Bijlenga - Division of Neurosurgery and

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 142

doi: 10.3205/15dgnc540, urn:nbn:de:0183-15dgnc5404

Published: June 2, 2015

© 2015 Gondar et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The natural history of unruptured incidentally discovered intracranial aneurysms (UIA) remains unpredictable. Therefore, when asymptomatic, the management remains subject of controversy. PHASES score1 was recently proposed for prediction of 5-year risk of rupture of UIA. The aim of this study is to validate the PHASES score using our prospective and consecutive dataset (2006-2014).

Method: We compared scores calculated from the untreated cohort of UIA (UIAFU) between cases with stable lesions and those with aneurysm growth or rupture as also as with those UIA initially treated (UIAIT). Secondly, scores calculated for UIA and patients diagnosed with Sub-Arachnoid Haemorrhage (SAH) were compared.

Results: Two hundred ninety one patients were followed up with a mean follow-up time of 3.2 years and 1177.6 aneurysm years. Twenty-nine cases were observed with growth aneurysms and two ruptures. PHASES score of patients with observed aneurysm growth or rupture showed a trend towards higher values (mean 3,9 ± 2,7 SD) than in patients with unruptured stable lesions (mean 3,0 ± 2,3 SD). Comparing 269 SAH patients with 291 cases of UIAIT and with the follow-up cohort, we observed that SAH patients had a significantly higher PHASES score (SAH: mean 5,6 ± 2,9 SD; UIAIT: mean 5,4 ± 3,14 SD; UIAFU: mean 3,0 ± 2,4 SD).

Conclusions: There’s a clear progression of PHASES score in our prospective cohort from UIAFU to SAH aneurysms with a treatment threshold above 3 that should be used with caution. It does not apply to patients with a familial history, PKD disease or symptomatic aneurysms and does not take into account smoking among other important risk factors.