Identifying patients at risk for postprocedural morbidity after treatment of incidental intracranial aneurysms: the role of aneurysm size and location

Abstract

Object A decision to treat incidental intracranial aneurysms (IIAs) relies on understanding the risks of treatment and weighing them against the those of aneurysm rupture. Whereas the natural history of IIAs is currently being studied, the risks associated with treating IIAs and factors associated with poor outcome need to be clearly established. Methods In a consecutive series of 125 patients, 160 IIAs were treated either surgically (152 cases) or endovascularly (eight cases). Postprocedural morbidity was defined as a new neurological deficit associated with a score greater than or equal to 3 on the modified Rankin Scale or a score of less than 24 on the Mini-Mental Status Examination. Logistic regression analysis was used to identify predictors of postprocedural morbidity from retrospectively collected data on demographic, clinical, and radiographic characteristics. Treatment of IIAs was not associated with any mortality and was associated with postprocedural morbidity in 17 (13.6%) of 125 patients (early outcome) and eight (6.4%) of patients (late outcome). In the logistic-regression model, treatment of aneurysms (≥13 mm) and posterior circulation aneurysms were independently associated with postprocedural morbidity. In patients in whom postprocedural neurological deficits developed, 12 (70.6%) of 17 and four (23.5%) of 17 patients harbored aneurysms with broad or calcified necks, respectively. Age, comorbidities, multiple aneurysms, specific aneurysm location, and history of subarachnoid hemorrhage related to a different aneurysm were not significantly associated with poor outcome. Conclusions The authors found that IIAs can be safely and effectively treated without causing mortality and with a lower morbidity rate than previously reported. A combination of radiographic variables may be helpful in identifying patients at risk for postprocedural morbidity.