Giordan Enrico, Lanzino Giuseppe, Rangel-Castilla Leonardo, Murad Mohammad Hassan, Brinjikji Waleed
1Department of Neurologic Surgery.
2Evidence-Based Practice Center, and.
J Neurosurg. 2018 Jul 6;131(1):14-24. doi: 10.3171/2018.1.JNS172450. Print 2019 Jul 1.
De novo aneurysms are rare entities periodically discovered during follow-up imaging. Little is known regarding the frequency with which these lesions form or the time course. This systematic review and meta-analysis was undertaken to estimate the incidence of de novo aneurysms and to determine risk factors for aneurysm formation.
The authors searched multiple databases for studies of patients with unruptured and ruptured aneurysms describing the rate of de novo aneurysm formation. The primary outcome was incidence of de novo aneurysm formation. A meta-analysis was performed using a random-effects model. The authors examined the associations of multiple aneurysms, prior subarachnoid hemorrhage, smoking, sex, age at presentation, and hypertension with de novo aneurysm formation.
The meta-analysis included 14,968 aneurysm patients who received imaging follow-up from 35 studies. The overall incidence of de novo aneurysm formation was 2% (95% CI 2%-3%) over a mean follow-up time of 8.3 years. The estimated incidence density was 0.3%/patient-year. There was no statistically significant difference in rates of de novo aneurysm formation between patients who had ruptured aneurysms and those with unruptured aneurysms. In 8 studies, 11.2% of de novo aneurysms were found in patients with ≤ 5 years of follow-up and 88.8% were found at > 5 years. The mean time to rupture for de novo aneurysms was 10 years.
This systematic review demonstrates that formation of de novo aneurysms is rare. Overall, routine screening for de novo aneurysms is likely to be of low yield and could be performed at time intervals of at least 5 to 10 years.
新发动脉瘤是在随访影像学检查中定期发现的罕见病变。对于这些病变形成的频率或时间进程知之甚少。本系统评价和荟萃分析旨在估计新发动脉瘤的发生率，并确定动脉瘤形成的危险因素。
作者检索了多个数据库，以查找描述新发动脉瘤形成率的未破裂和破裂动脉瘤患者的研究。主要结局是新发动脉瘤形成的发生率。使用随机效应模型进行荟萃分析。作者研究了多发动脉瘤、既往蛛网膜下腔出血、吸烟、性别、就诊时年龄和高血压与新发动脉瘤形成之间的关联。
荟萃分析纳入了来自35项研究的14968例接受影像学随访的动脉瘤患者。在平均8.3年的随访时间内，新发动脉瘤形成的总体发生率为2%（95%CI 2%-3%）。估计的发病密度为0.3%/患者年。破裂动脉瘤患者和未破裂动脉瘤患者的新发动脉瘤形成率在统计学上无显著差异。在8项研究中，11.2%的新发动脉瘤在随访≤5年的患者中发现，88.8%在>5年时发现。新发动脉瘤破裂的平均时间为10年。
本系统评价表明，新发动脉瘤的形成很罕见。总体而言，对新发动脉瘤进行常规筛查的收益可能较低，可至少每隔5至10年进行一次。
