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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Analysis of the risk of rupture of unruptured aneurysms in patients with aneurysmal subarachnoid hemorrhage according to the PHASES score

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  • Belal Neyazi - KRH Klinikum Nordstadt, Neurochirurgie, Hannover, Deutschland
  • Homajoun Maslehaty - KRH Klinikum Nordstadt, Neurochirurgie, Hannover, Deutschland
  • I. Erol Sandalcioglu - KRH Klinikum Nordstadt, Neurochirurgie, Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV084

doi: 10.3205/18dgnc085, urn:nbn:de:0183-18dgnc0859

Published: June 18, 2018

© 2018 Neyazi 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 PHASES score was developed to determine the risk of rupture of un-ruptured intracranial aneurysms (UIAs). The purpose of the current study was to apply this score on patients with actually ruptured intracranial aneurysms and to analyze the hypothetical prediction of the risk in this particularly patient group.

Methods: We extracted the data of the last 100 patients (23 male, 77 female, mean age 56.4 years, range 17-93 years) with ruptured saccular intracranial aneurysms from 2014-2016 from our prospectively maintained neurovascular database according to the parameters used in the PHASES score (population, hypertension, age, earlier SAH, size and site of the aneurysm). According to the estimated 5year risk of rupture of PHASES study,we divided the patients into 2 groups (risk of rupture <2% [0 to 6 points] and >2% [7 to >12 points]). Descriptive statistical analysis was performed using SPSS for Windows version 18.0 (SPSS Inc., Chicago, Illinois, USA).

Results: 99% of the patients were European and 1% Japanese in our series. Pre-existing arterial hypertension was found in 59%. 15% of the patients were > 75 years. Earlier SAH was found in 1%. The site of the aneurysms were the internal carotid artery (ICA) in 10%, the middle cerebral artery (MCA) in 14% and arteries of the anterior and posterior circulation including the posterior communicating artery (PCOM) in 76%. 66% of the aneurysms were smaller than 7mm, 18% ranged between 7-9.9mm, 14% were between 10-19.9mm and 2% were larger than 20mm.

European descent, aneurysm size <7mm and age <75 years scored with 0 points in the PHASES study and occurred most frequently in our series. The distribution of the aneurysm site to the anterior and posterior circulation scored with 4 points occurred most frequently. Considering the 5 year risk of rupture 70% of our patient collective would have an estimated risk of <2%.

Conclusion: Interestingly, 70% of the patients with aneurysmal SAH had a low risk profile and would have a low risk of rupture according to the PHASES score in our series. This observation underlines the discrepancy of the estimated low risk of rupture for unruptured intracranial aneurysms in young and healthy patients and the obvious fact that the majority of the SAH patients are actually young with low risk factors. Parameters beyond the features of the PHASES score are needed to determine the risk of rupture of intracranial aneurysms.