Hall Samuel, Abouharb Ashraf, Anderson Ian, Bacon Andrew, Bahl Anuj, Brydon Howard, Dow Graham, Fouyas Ioannis, Galea James, Ghosh Anthony, Gurusinghe Nihal, Kamel Mahmoud, Minhas Pawan, Mitchell Patrick, Mowle David, Mukerji Nitin, Nair Ramesh, Norris John, Patel Hiren, Patel Jash, Patel Krunal, St George Jerome, Teo Mario, Toma Ahmed, Trivedi Rikin, Uff Chris, Visca Anna, Walsh Daniel C, White Edward, Whitfield Peter, Bulters Diederik
Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
Department of Neurosurgery, Belfast Health and Social Care Trust, Belfast, UK.
Br J Neurosurg. 2023 Apr;37(2):163-169. doi: 10.1080/02688697.2021.1995587. Epub 2021 Nov 5.
Unruptured intracranial aneurysms (UIA) are common. For many the treatment risks outweigh their risk of subarachnoid haemorrhage and patients undergo surveillance imaging. There is little data to inform if and how to monitor UIAs resulting in widely varying practices. This study aimed to determine the current practice of unruptured UIA surveillance in the United Kingdom.
A questionnaire was designed to address the themes of surveillance protocols for UIA including when surveillance is initiated, how frequently it is performed, and when it is terminated. Additionally, how aneurysm growth is managed and how clinically meaningful growth is defined were explored. The questionnaire was distributed to members of the British Neurovascular Group using probability-based cluster and non-probability purposive sampling methods.
Responses were received from 30 of the 30 (100.0%) adult neurosurgical units in the United Kingdom of which 27 (90.0%) routinely perform surveillance for aneurysm growth. Only four units had a unit policy. The mean patient age up to which a unit would initiate follow-up of a low-risk UIA was 65.4 ± 9.0 years. The time points at which imaging is performed varied widely. There was an even split between whether units use a fixed duration of follow-up or an age threshold for terminating surveillance. Forty percent of units will follow-up patients more than 5 years from diagnosis. The magnitude in the change in size that was felt to constitute growth ranged from 1 to 3mm. No units routinely used vessel wall imaging although 27 had access to 3T MRI capable of performing it.
There is marked heterogeneity in surveillance practices between units in the United Kingdom. This study will help units better understand their practice relative to their peers and provide a framework forplanning further research on aneurysm growth.
未破裂颅内动脉瘤（UIA）很常见。对许多患者而言，治疗风险超过了蛛网膜下腔出血的风险，因此患者接受监测成像。几乎没有数据可指导是否以及如何监测UIA，导致实践差异很大。本研究旨在确定英国未破裂UIA监测的当前实践情况。
设计了一份问卷，以探讨UIA监测方案的主题，包括何时开始监测、监测频率以及何时终止监测。此外，还探讨了如何处理动脉瘤生长以及如何定义具有临床意义的生长。该问卷通过基于概率的整群抽样和非概率目的抽样方法分发给英国神经血管组的成员。
英国30个成人神经外科单位中有30个（100.0%）回复了问卷，其中27个（90.0%）常规对动脉瘤生长进行监测。只有四个单位有单位政策。一个单位开始对低风险UIA进行随访的平均患者年龄为65.4±9.0岁。进行成像的时间点差异很大。单位在使用固定随访期限还是年龄阈值来终止监测方面各占一半。40%的单位会对诊断后超过5年的患者进行随访。被认为构成生长的大小变化幅度为1至3毫米。没有单位常规使用血管壁成像，尽管有27个单位可以使用能够进行血管壁成像的3T MRI。
英国各单位之间的监测实践存在明显异质性。本研究将帮助各单位更好地了解其相对于同行的实践情况，并为规划进一步的动脉瘤生长研究提供框架。
