Small Aneurysms with Low PHASES Scores Account for Most Subarachnoid Hemorrhage Cases

2020 ◽  
Vol 139 ◽  
pp. e580-e584 ◽  
Author(s):  
Caleb Rutledge ◽  
Soren Jonzzon ◽  
Ethan A. Winkler ◽  
Daniel Raper ◽  
Michael T. Lawton ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Small Aneurysms

scholarly journals Frontobasal Aneurysm: Relatively a Rare Neurosurgical Entity

2016 ◽  
Vol 12 (2) ◽  
pp. 91-93
Author(s):  
Prabin Shrestha ◽  
Anish M Singh ◽  
Hemant Sah
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Male Patient ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Pterional Craniotomy ◽  
Basal Branch ◽  
Distal Anterior Cerebral Artery ◽  
Small Aneurysms

Distal Anterior Cerebral Artery (DACA) aneurysms are rarer. Its more so with the aneurysm of fronto basal branch of DACA. These aneurysms are smaller in size and are multiple in number in many instances. They rupture easily and present with intracerebral hemorrhage (ICH) in addition to subarachnoid hemorrhage (SAH).Here we present a male patient with SAH and left frontal base interhemispheric ICH. CT angiography showed multiple small aneurysms at right frontobasal artery. Successful clipping of all the aneurysms was done in the single sitting by left pterional craniotomy and subfrontal and interhemispheric approach.Nepal Journal of Neuroscience 12:91-93, 2015   

Small Aneurysms Account for the Majority and Increasing Percentage of Aneurysmal Subarachnoid Hemorrhage: A 25-Year, Single Institution Study

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 692-699 ◽  
Author(s):  
Matthew T Bender ◽  
Haley Wendt ◽  
Thomas Monarch ◽  
Narlin Beaty ◽  
Li-Mei Lin ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Clinical Role ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Institutional Review ◽  
Common Clinical Practice ◽  
Average Size ◽  
Risk Of Treatment ◽  
Small Aneurysms

Abstract BACKGROUND Prospective studies of unruptured aneurysms have shown very low rates of rupture for small aneurysms (<10 mm) and suggested that the risk of treatment outweighs benefit. However, common clinical practice shows that patients with aneurysmal subarachnoid hemorrhage (aSAH) frequently have small aneurysms. OBJECTIVE To investigate trends in size and location of ruptured aneurysms over a 25-yr period. METHODS A prospective, Institutional Review Board-approved database of all patients presenting to our institution with aSAH from 1991 to 2016 was analyzed. Cerebral angiography identified the source of hemorrhage. Patients with nonaneurysmal etiologies were excluded. RESULTS Complete data were available for 1306/1562 patients (84%) with aSAH from 1991 to 2016. The average age was 53 yr and 72% of patients were female. The average size of ruptured aneurysms over 25 yr was 8.0 mm. The average size of ruptured aneurysms decreased steadily with each 5-yr interval from 10.1 mm (1991-1996) to 6.6 mm (2012-2016; P < .001). Overall, very small aneurysms (<5 mm) were responsible for aSAH in 41% of patients. The percentage of very small ruptured aneurysms rose from 29% during the initial 5-yr period (1991-1996) to 50% in the most recent period. Likewise, the percentage of ruptured aneurysms that were 5 to 9 mm rose from 26% to 34% (P < .001). In the past 5 yr, aneurysms <10 mm accounted for 84% of aSAH. Vessel of origin (P = .097) and aneurysm location (P = .322) did not vary with time. CONCLUSION Ruptured small and very small aneurysms represent a majority and increasing share of aSAH. Identification and prophylactic treatment of these aneurysms remains an important clinical role for cerebrovascular neurosurgery.

scholarly journals Small Aneurysms With Low Rupture Risk Account for a Majority of Subarachnoid Hemorrhage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Caleb Rutledge ◽  
Soren Jonzzon ◽  
Ethan A Winkler ◽  
Kunal P Raygor ◽  
Michael T Lawton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Standard Deviation ◽  
Natural History ◽  
Risk Score ◽  
Clinical Decision Making ◽  
Consecutive Series ◽  
Risk Of Rupture ◽  
The Mean ◽  
Small Aneurysms

Abstract INTRODUCTION Small, unruptured cerebral aneurysms are frequently found incidentally, but management remains controversial because of their uncertain natural history. Based on prospective studies, the rupture rate for small aneurysms is minimal. As a result, in the absence of other high-risk factors, small aneurysms are generally observed. However, subarachnoid hemorrhage (SAH) from small aneurysms is commonly observed in practice. Patient- and aneurysm-related risk factors for rupture, including a risk score (PHASES), help guide clinical decision-making. To determine the usefulness of size and the PHASES risk score as predictors of rupture, we studied a consecutive series of ruptured aneurysms over a 10-yr period. METHODS We identified 629 patients with aneurysmal SAH at our hospital treated by the senior authors between 2008 and 2018. We collected patient data including population, hypertension, age, size of aneurysm, earlier SAH from another aneurysm, and site of aneurysm. A PHASES score was calculated in each case to estimate a predicted risk of rupture. RESULTS The mean aneurysm size was 6.1 mm (standard deviation 3.9). Almost 3 quarters of aneurysms were less than 7 mm. The mean PHASES score was 4.9 (standard deviation 2.6). CONCLUSION In our cohort, small aneurysms < 7 mm accounted for a majority of SAH cases. Furthermore, the mean PHASES score corresponded to a 5-yr risk of rupture of only 1.3%. Many, if not most, of our patients would have been conservatively managed. Natural history studies have selection bias and may underestimate the risk of rupture.

A Review of Size and Location of Ruptured Intracranial Aneurysms

Neurosurgery ◽  
2001 ◽  
Vol 49 (6) ◽  
pp. 1322-1326 ◽  
Author(s):  
Thomas R. Forget ◽  
Ronald Benitez ◽  
Erol Veznedaroglu ◽  
Ashwini Sharan ◽  
William Mitchell ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Patient Population ◽  
Intracranial Aneurysms ◽  
Thomas Jefferson ◽  
Posterior Communicating Artery ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Ruptured Intracranial Aneurysms ◽  
Small Aneurysms

ABSTRACT OBJECTIVE To review our experience and examine the size at which aneurysms ruptured in our patient population. METHODS Patient charts and angiograms for all patients admitted with a diagnosis of subarachnoid hemorrhage to the Thomas Jefferson/Wills Eye Hospital between April 1996 and March 2000 were reviewed. RESULTS Of the 362 cases reviewed, definite measurements of the ruptured aneurysm were obtained in 245. The data clearly showed that most ruptured aneurysms presenting to our institution were less than 10 mm in diameter. We found that, regardless of location on the circle of Willis, 85.6% of all aneurysms presenting with rupture were less than 10 mm. Review by location shows that aneurysms of the anterior communicating artery most often presented with rupture at sizes less than 10 mm (94.4%). A large number of ruptured posterior communicating artery aneurysms also presented at sizes less than 10 mm (87.5%). This trend continued for all aneurysm sites in our review. The incidence of subarachnoid hemorrhage in Western countries is estimated at 10 per 100,000 people per year. Recent reports have indicated that aneurysms less than 10 mm in size are unlikely to rupture. CONCLUSION We argue that the risk of small aneurysms rupturing is not insignificant, especially those of the anterior communicating artery. Our findings indicate that surgery on unruptured aneurysms should not be predicated on aneurysm size alone.

scholarly journals Aneurysmal Subarachnoid Hemorrhage Associated with Small Aneurysms in Smokers and Women: A Retrospective Analysis

2019 ◽  
Vol 4 ◽  
pp. 100038 ◽  
Author(s):  
Luisa F. Figueredo ◽  
María Camila Pedraza-Ciro ◽  
Juan Sebastian Lopez-McCormick ◽  
Roberto Javier Rueda-Esteban ◽  
Juan Armando Mejía-Cordovez
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Retrospective Analysis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Small Aneurysms

Endovascular treatment of very small intracranial aneurysms

2010 ◽  
Vol 112 (3) ◽  
pp. 551-556 ◽  
Author(s):  
Ioannis Ioannidis ◽  
Shivendra Lalloo ◽  
Rufus Corkill ◽  
Wilhelm Kuker ◽  
James V. Byrne
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Endovascular Procedures ◽  
Thromboembolic Events ◽  
Technical Challenge ◽  
Angiographic Evidence ◽  
Intraoperative Rupture ◽  
Small Aneurysms

Object Endovascular treatment of very small aneurysms poses a significant technical challenge for endovascular therapists. The authors review their experience with a series of patients who had intracranial aneurysms smaller than 3 mm in diameter. Methods Between 1995 and 2006, 97 very small aneurysms (defined for purposes of this study as < 3 mm in diameter) were diagnosed in 94 patients who were subsequently referred for endovascular treatment. All patients presented after subarachnoid hemorrhage, which was attributed to the very small aneurysms in 85 patients. The authors reviewed the endovascular treatment, the clinical and angiographic results of the embolization, and the complications. Results Five (5.2%) of the 97 endovascular procedures failed, and these patients underwent craniotomy and clip ligation. Of the 92 aneurysms successfully treated by coil embolization, 64 (69.6%) were completely occluded and 28 (30.4%) showed minor residual filling or neck remnants on the immediate postembolization angiogram. Complications occurred in 7 (7.2%) of 97 procedures during the treatment (3 thromboembolic events [3.1%] and 4 intraprocedural ruptures [4.1%]). Seventy-six patients were followed up angiographically; 4 (5.3%) of these 76 showed angiographic evidence of recanalization that required retreatment. The clinical outcomes for the 76 patients were also graded using the Glasgow Outcome Scale. In 61 (80.3%) cases the outcomes were graded 4 or 5, whereas in 15 (19.7%) they were graded 3. Seven patients (7.4%) died (GOS Grade 1), 2 due to procedure-related complications (intraoperative rupture) and 5 due to complications related to the presenting subarachnoid hemorrhage. Conclusions Endosaccular coil embolization of very small aneurysms is associated with relatively high rates of intraprocedural rupture, especially intraoperative rupture. With the advent of more sophisticated endovascular materials (microcatheters and microguidewires, soft and ultrasoft coils, and stents) endovascular procedures have become feasible and can lead to a good angiographic outcome.

Documented enlargement and rupture of a small arterial sacculation

1971 ◽  
Vol 34 (6) ◽  
pp. 814-817 ◽  
Author(s):  
Byron Young ◽  
William F. Meacham ◽  
Joseph H. Allen
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Content Type ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Small Aneurysms ◽  
Fine Print

✓ Small aneurysms may sometimes be considered junctional dilatations but may also progressively enlarge and cause spontaneous subarachnoid hemorrhage, as in the case reported. These small aneurysms should be treated precisely as an aneurysm directly responsible for bleeding. When found in conjunction with other aneurysms, they should either be treated simultaneously or followed until clinical developments indicate the need for such surgery.

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