137 A Review of Current Criteria for Risk of Aneurysmal Subarachnoid Haemorrhage. (28th February 2022)

• Record Type: Journal Article
• Authors: Sharma, S.; Daga, K.
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 1
• Publication Date: 2022-02-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac039.078
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: There is a need to evaluate the existing guidelines regarding the size criteria for the risk of rupture of intracranial aneurysms. The current understanding is that small intracranial aneurysms (less than 7 mm) are not at significant risk for rupture according to the ISUIA 1 & 2 trials. However, there have been several published series of rupture and subarachnoid haemorrhage from aneurysms less than 5 mm in both, anterior and posterior cerebral circulation. Methods: We conducted a systematic review of aneurysmal subarachnoid haemorrhage, specifically to identify their size and the anatomical location at the time of rupture, using the healthcare databases advanced search. Results: Our search yielded 1438 results matching our inclusion criteria. Our results demonstrated that 50.4 – 76.8% of aneurysms were under 7 mm in diameter at the time of rupture. Subarachnoid haemorrhage from smaller aneurysms (<5 mm) was also shown to present with poor prognoses (Hunt and Hess grades 4–5). There were no significant differences observed between the anterior and posterior circulation. Conclusions: The existing criterion to determine the risk of rupture of intracranial aneurysms need to be updated, accounting for multiple clinical factors including, but not limited to, the size. With advances in endovascular treatments in recent years, the associated intra-procedural risks are greatly reduced compared to traditional neurosurgical approaches, making the argument for intervention at earlier presentations.