gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Systematic review and meta-analysis on intracranial aneurysm growth and associated risk factors

Meeting Abstract

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  • Philippe Bijlenga - Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
  • Renato Gondar - Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
  • Sandrine Morel - Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
  • Fabienne Perren - Neurology Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
  • Zsolt Kulcsar - Interventional Neuroradiology Division, Department of Radiology and Medical Informatics, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
  • Karl Schaller - Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.02.02

doi: 10.3205/16dgnc002, urn:nbn:de:0183-16dgnc0020

Published: June 8, 2016

© 2016 Bijlenga 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

Text

Objective: The natural history and management of Unruptured Intracranial Aneurysms (UIA) remains controversial. The aim is to review current knowledge regarding intracranial aneurysm growth from the clinical perspective, identify predictive factors and quantify their relative weight.

Method: A Pubmed and Web of Science search was performed using the keywords “intracranial aneurysm” AND “aneurysm growth” AND “associated factors”. Thirteen original publications with quantitative data were identified. Growth probability, risk of aneurysm rupture and odds ratio of aneurysm growth versus stable status associated with different predictive factors was calculated.

Results: Three hundred events of aneurysm growth were observed by following 3079 patients and 3855 aneurysms during a total follow-up time of 7799.1 patients’ years. The annual patient probability to be diagnosed with an aneurysm growth is 3.85% (95%CI: 3.4-4.3%). The growth probability seems constant over time. The probability of aneurysm rupture in the observed cohort is 0.5% per year (95%CI: 0.3- 0.7%) and increases by at least a factor ten if an aneurysm growth is observed (11.5% per year; 95%CI: 5-21%). Patients with multiple aneurysms (OR, 2.5; 95%CI: 1.7-3.7), high blood pressure (OR, 1.6; 95%CI: 1.1-2.4), female gender (OR, 1.4; 95%CI: 1.0-1.8), aneurysm with a size larger than 4mm (OR, 2.2; 95%CI: 1.2-4.3), with lobules (OR, 3.4; 95%CI: 1.5-7.6) and located in the posterior circulation including posterior communicating artery (OR, 1.6; 95%CI: 1.1-2.2) are more likely to experience an aneurysm growth.

Conclusions: Carefully selected patients with UIA (<7mm in low risk location and <4mm in high risk location) followed during 5 five years are not exposed to a higher risk of mortality/morbidity than treated patients. Aneurysm growth is associated with a high risk of aneurysm rupture. Aneurysm growth and rupture share common predictive factors. It is legitimate to propose aneurysm growth as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction.