Analysis for risk factors of 12-month neurological worsening in patients with surgically treated small-to-moderate size unruptured intracranial aneurysms. (December 2018) - Matsukawa, Hidetoshi
Highlights: 971 non-large unruptured intracranial aneurysms (<15 mm) was evaluated. Neurological worsening (NW) was defined as an increase of modified Rankin Scale (≧1). Perforator territory infarction (PTI) and aneurysm site were related to 12-month NW. Aneurysm site and size (>10 mm) and statin use were related to PTI. Abstract: The risk associated with surgical treatment for small-to-moderate size unruptured intracranial aneurysms (SMUIAs, defined as <15 mm) has not been well characterized. Authors aimed to investigate risk factors for poor outcome in surgical treatment of SMUIAs. The data of prospectively collected 801 consecutive patients harboring 971 surgically treated SMUIAs was evaluated. Neurological worsening (NW) was defined as an increase in 1 or more modified Rankin Scale at 12-month. Clinical and radiological characteristics were compared. Neurological worsening was observed in 45 (4.6%). In multivariate analysis, only perforator territory infarction (PTI) on postoperative diffusion-weighted imaging (odds ratio (OR), 13; 95% confidence interval (CI), 4.9–32, p < 0.0001), and aneurysm locations (paraclinoid (OR, 6.9; 95% CI, 3.1–15, p < 0.0001), basilar artery (OR, 4.5; 95% CI, 1.5–14, p = 0.008), vertebral artery (OR, 11; 95% CI, 3.3–34, p < 0.0001)) were related to neurological worsening. Multivariate analysis showed that statin use (OR, 12; 95% CI, 3.8–39, p < 0.0001) and aneurysm locations (internal carotid artery-posterior communicating artery (OR, 3.9; 95% CI, 1.8–8.2, p < 0.0001) and basilar artery (OR, 6.3; 95% CI, 2.3–17, p = 0.008)), and aneurysm size >10 mm (OR, 5.3; 95% CI, 1.8–15, p = 0.003) were related to PTI. Although all SMUIAs should be carefully considered whether to be treated, those with statins, specific locations, and larger sizes should perhaps be more meticulously contemplated, and neurosurgeons should continue to avoid PTI.