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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(02): 422-426
DOI: 10.4103/ajns.AJNS_161_18
Original Article

Small aneurysms should be clipped?

Gustavo Noleto
Department of Neurosurgery, University of São Paulo Medical School, São Paulo
,
Nícollas Rabelo
Department of Neurosurgery, University of São Paulo Medical School, São Paulo
,
Leonardo Abaurre
Department of Neurosurgery, University of São Paulo Medical School, São Paulo
,
Hugo Neto
Department of Neurosurgery, University of São Paulo Medical School, São Paulo
,
Mario Siqueira
Department of Neurosurgery, University of São Paulo Medical School, São Paulo
,
Manoel Teixeira
1   Department of Neurosurgery, São Paulo University, São Paulo
,
Eberval Figueiredo
Department of Neurosurgery, University of São Paulo Medical School, São Paulo
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Background: Cerebral aneurysm prevalence may vary from 0.4% to 10%. The decision to treat or not incidental aneurysms remains controversial, especially when the lesions are small (<5 mm). Many recent publications are demonstrating that these lesions often bleed. Methods: We reviewed admitted patients with angiographic studies submitted to intracranial aneurysm surgical treatment from April 2012 to July 2013 in the Neurosurgery Department of São Paulo Medical School University (15 months), to define the rate and risk of bleeding. In addition, we proceeded literature review with collected 357 papers (past 5 years) which were selected 50 that were focused on our research. Clinical patients' status at the time of discharge was evaluated with the modified Rankin scale. Results: A series of 118 cases of surgically clipped aneurysms was analyzed: 73.7% woman; Ruptured (61 cases, 51%); middle cerebral artery (51 cases, 43%) was the more common aneurysm. Small size (<5 mm) was 25 cases (21%); that 2 died (16%), 3 (25%) with severe disability,restricted to bed and dependent on nursing care; blood pressure was the main risk factors (56%); and an aneurysm <2 mm (100%) was ruptured. Conclusion: The number of small aneurysms in our series was significant (25 cases, 21%), and its rate of bleeding was high (25 cases, 48%), resulting in death and disability in a significant number of cases. Our tendency is for surgical treatment when it is associated with risk factors.

Key-words:

Aneurysm clipped - cerebral hemorrhage - intracranial aneurysm - small cerebral aneurysm - subarachnoid hemorrhage

Financial support and sponsorship

Nil.




Publikationsverlauf

Artikel online veröffentlicht:
09. September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chason JL, Hindman WM. Berry aneurysms of the circle of Willis; results of a planned autopsy study. Neurology 1958;8:41-4.
  • 2 Inagawa T, Hirano A. Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 1990;34:361-5.
  • 3 Ishibashi T, Murayama Y, Urashima M, Saguchi T, Ebara M, Arakawa H, et al. Unruptured intracranial aneurysms: Incidence of rupture and risk factors. Stroke 2009;40:313-6.
  • 4 Iwamoto H, Kiyohara Y, Fujishima M, Kato I, Nakayama K, Sueishi K, et al. Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama study. Stroke 1999;30:1390-5.
  • 5 Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103-10.
  • 6 Forget TR Jr., Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, et al. Areview of size and location of ruptured intracranial aneurysms. Neurosurgery 2001;49:1322-5.
  • 7 Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 1991;75:8-14.
  • 8 Russell SM, Lin K, Hahn SA, Jafar JJ. Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: A radiological investigation and discussion of theoretical determinants. J Neurosurg 2003;99:248-53.
  • 9 Roos EJ, Rinkel GJ, Velthuis BK, Algra A. The relation between aneurysm size and outcome in patients with subarachnoid hemorrhage. Neurology 2000;54:2334-6.
  • 10 Fogelholm R, Hernesniemi J, Vapalahti M. Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage. A population-based study. Stroke 1993;24:1649-54.
  • 11 van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain 2001;124:249-78.
  • 12 Maslehaty H, Ngando H, Meila D, Brassel F, Scholz M, Petridis AK, et al. Estimated low risk of rupture of small-sized unruptured intracranial aneurysms (UIAs) in relation to intracranial aneurysms in patients with subarachnoid haemorrhage. Acta Neurochir (Wien) 2013;155:1095-100.
  • 13 Salary M, Quigley MR, Wilberger JE Jr. Relation among aneurysm size, amount of subarachnoid blood, and clinical outcome. J Neurosurg 2007;107:13-7.
  • 14 Weir B, Disney L, Karrison T. Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 2002;96:64-70.
  • 15 Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke 2010;41:1969-77.
  • 16 Juvela S, Porras M, Heiskanen O. Natural history of unruptured intracranial aneurysms: A long-term follow-up study. J Neurosurg 1993;79:174-82.
  • 17 Beck J, Rohde S, Berkefeld J, Seifert V, Raabe A. Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography. Surg Neurol 2006;65:18-25.
  • 18 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: Probability of and risk factors for aneurysm rupture. J Neurosurg 2008;108:1052-60.
  • 19 Ohashi Y, Horikoshi T, Sugita M, Yagishita T, Nukui H. Size of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage. Surg Neurol 2004;61:239-45.
  • 20 Kashiwazaki D, Kuroda S; Sapporo SAH Study Group. Size ratio can highly predict rupture risk in intracranial small (<5 mm) aneurysms. Stroke 2013;44:2169-73.
  • 21 Dhar S, Tremmel M, Mocco J, Kim M, Yamamoto J, Siddiqui AH, et al. Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 2008;63:185-96.
  • 22 Nahed BV, DiLuna ML, Morgan T, Ocal E, Hawkins AA, Ozduman K, et al. Hypertension, age, and location predict rupture of small intracranial aneurysms. Neurosurgery 2005;57:676-83.
  • 23 Hamada J, Morioka M, Yano S, Kai Y, Ushio Y. Incidence and early prognosis of aneurysmal subarachnoid hemorrhage in Kumamoto Prefecture, Japan. Neurosurgery 2004;54:31-7.
  • 24 International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms – Risk of rupture and risks of surgical intervention. N Engl J Med 1998;339:1725-33.
  • 25 Juvela S. Prevalence of and risk factors for intracranial aneurysms. Lancet Neurol 2011;10:595-7.
  • 26 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: Probability of and risk factors for aneurysm rupture. J Neurosurg 2000;93:379-87.
  • 27 Tsutsumi K, Ueki K, Morita A, Kirino T. Risk of rupture from incidental cerebral aneurysms. J Neurosurg 2000;93:550-3.
  • 28 Raymond J, Guillemin F, Proust F, Molyneux AJ, Fox AJ, Claiborne JS, et al. Unruptured intracranial aneurysms. A Critical review of the international study of unruptured intracranial aneurysms (ISUIA) and of appropriate methods to address the clinical problem. Interv Neuroradiol 2008;14:85-96.
  • 29 Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC Jr., Brott T, et al. Recommendations for the management of patients with unruptured intracranial aneurysms: A Statement for healthcare professionals from the stroke council of the American Heart Association. Stroke 2000;31:2742-50.
  • 30 Komotar RJ, Mocco J, Solomon RA. Guidelines for the surgical treatment of unruptured intracranial aneurysms: The first annual J. Lawrence pool memorial research symposium – Controversies in the management of cerebral aneurysms. Neurosurgery 2008;62:183-93.
  • 31 Güresir E, Vatter H, Schuss P, Platz J, Konczalla J, de Rochement Rdu M, et al. Natural history of small unruptured anterior circulation aneurysms: A prospective cohort study. Stroke 2013;44:3027-31.
  • 32 Kemp WJ 3rd, Fulkerson DH, Payner TD, Leipzig TJ, Horner TG, Palmer EL, et al. Risk of hemorrhage from de novo cerebral aneurysms. J Neurosurg 2013;118:58-62.
  • 33 Raabe A, Seifert V, Schmiedek P, Steinmetz H, Bertalanffy H, Steiger HJ, et al. Recommendations for the management of unruptured intracranial aneurysms. Zentralbl Neurochir 2002;63:70-6.
  • 34 Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: An updated meta-analysis. Stroke 2007;38:1404-10.
  • 35 Sato K, Yoshimoto Y. Risk profile of intracranial aneurysms: Rupture rate is not constant after formation. Stroke 2011;42:3376-81.
  • 36 Kalani MY, Zabramski JM, Kim LJ, Chowdhry SA, Mendes GA, Nakaji P, et al. Long-term follow-up of blister aneurysms of the internal carotid artery. Neurosurgery 2013;73:1026-33.
  • 37 Signorelli F, Scholtes F, Bojanowski MW. Very small intracranial aneurysms: Clip or coil. Neurochirurgie 2012;58:156-9.
  • 38 Chien A, Liang F, Sayre J, Salamon N, Villablanca P, Viñuela F, et al. Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: The different factors related to the growth of single and multiple aneurysms. J Neurosurg 2013;119:190-7.
  • 39 Chien A, Sayre J, Viñuela F. Comparative morphological analysis of the geometry of ruptured and unruptured aneurysms. Neurosurgery 2011;69:349-56.
  • 40 Matsubara S, Hadeishi H, Suzuki A, Yasui N, Nishimura H. Incidence and risk factors for the growth of unruptured cerebral aneurysms: Observation using serial computerized tomography angiography. J Neurosurg 2004;101:908-14.
  • 41 Ohman J, Heiskanen O. Timing of operation for ruptured supratentorial aneurysms: A prospective randomized study. J Neurosurg 1989;70:55-60.
  • 42 Whitfield PC, Kirkpatrick PJ. Timing of surgery for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2001;(2):CD001697.
  • 43 Kassell NF, Torner JC, Haley EC Jr., Jane JA, Adams HP, Kongable GL, et al. The international cooperative study on the timing of aneurysm surgery. Part 1: Overall management results. J Neurosurg 1990;73:18-36.
  • 44 Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, et al. Clipping versus coiling for ruptured intracranial aneurysms: A systematic review and meta-analysis. Stroke 2013;44:29-37.
  • 45 Fraser JF, Riina H, Mitra N, Gobin YP, Simon AS, Stieg PE, et al. Treatment of ruptured intracranial aneurysms: Looking to the past to register the future. Neurosurgery 2006;59:1157-66.
  • 46 Taylor CL, Steele D, Kopitnik TA Jr., Samson DS, Purdy PD. Outcome after subarachnoid hemorrhage from a very small aneurysm: A case-control series. J Neurosurg 2004;100:623-5.
  • 47 Sluzewski M, Bosch JA, van Rooij WJ, Nijssen PC, Wijnalda D. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: Incidence, outcome, and risk factors. J Neurosurg 2001;94:238-40.
  • 48 van Rooij WJ, Sluzewski M, Beute GN, Nijssen PC. Procedural complications of coiling of ruptured intracranial aneurysms: Incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 2006;27:1498-501.