Dodier Philippe, Lederer Philip, Ecker Bernhard, Dogan Muhammet, Strasser Elisabeth, Cho Anna, Hirschmann Dorian, Wang Wei-Te, Dorfer Christian, Haider Lukas, Hosmann Arthur, Gruber Andreas, Bavinzski Gerhard, Rössler Karl, Frischer Josa M
1Department of Neurosurgery and.
2Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna; and.
J Neurosurg. 2025 May 30;143(3):641-653. doi: 10.3171/2025.1.JNS241986. Print 2025 Sep 1.
The management of unruptured intracranial aneurysms (UIAs) remains controversial, with a scarcity of long-term natural history data on conservative management. Therefore, the authors attempted to identify risk factors for aneurysm rupture in a cohort of consecutive patients with UIAs.
In this retrospective observational study, the authors analyzed 661 patients with 767 exclusively UIAs who were conservatively managed at their tertiary referral center between 1984 and 2020. Patient-specific and aneurysm-specific risk factors for hemorrhage and aneurysm-related death were analyzed, including thresholds for the PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, and site of aneurysm) and ELAPSS (earlier subarachnoid hemorrhage, aneurysm location, age, population, aneurysm size and shape) scores that were set at 8 and 15, respectively, prior to the analyses.
The median follow-up in the conservative observation period was 4.1 years, with 42% of the patients observed for ≥ 5 years. The overall aneurysm-related mortality rate was 4.4%. In 23 (3.5%) patients, aneurysm rupture was reported during the conservative observation period, resulting in an overall calculated annual hemorrhage rate of 0.6%. Notably, 87% of the hemorrhages occurred in the first 5 years after diagnosis, whereas no single rupture occurred after 10 years. Aneurysm size and PHASES and ELAPSS scores were independent predictors of hemorrhage. Among patients with a PHASES score < 8 or an ELAPSS score < 15, no aneurysm-related death or aneurysm rupture occurred.
The identified PHASES and ELAPSS score thresholds may help identify high-risk patients with UIAs. Individual aneurysm rupture risks must be carefully weighed against center-specific treatment outcomes. For conservatively managed UIAs, lifelong regular follow-up is recommended and seems to be especially important in the first 10 years after diagnosis.
未破裂颅内动脉瘤（UIA）的管理仍存在争议，保守治疗的长期自然史数据匮乏。因此，作者试图在一组连续的UIA患者中确定动脉瘤破裂的危险因素。
在这项回顾性观察研究中，作者分析了1984年至2020年间在其三级转诊中心接受保守治疗的661例患者的767个单纯UIA。分析了出血和动脉瘤相关死亡的患者特异性和动脉瘤特异性危险因素，包括在分析前分别设定为8和15的PHASES（人群、高血压、年龄、动脉瘤大小、另一动脉瘤先前的蛛网膜下腔出血和动脉瘤部位）和ELAPSS（先前的蛛网膜下腔出血、动脉瘤位置、年龄、人群、动脉瘤大小和形状）评分阈值。
保守观察期的中位随访时间为4.1年，42%的患者观察时间≥5年。总体动脉瘤相关死亡率为4.4%。在23例（3.5%）患者中，保守观察期内报告了动脉瘤破裂，总体计算的年出血率为0.6%。值得注意的是，87%的出血发生在诊断后的前5年，而10年后没有发生单次破裂。动脉瘤大小以及PHASES和ELAPSS评分是出血的独立预测因素。在PHASES评分<8或ELAPSS评分<15的患者中，未发生动脉瘤相关死亡或动脉瘤破裂。
确定的PHASES和ELAPSS评分阈值可能有助于识别UIA的高危患者。必须仔细权衡个体动脉瘤破裂风险与中心特异性治疗结果。对于接受保守治疗的UIA，建议进行终身定期随访，并且在诊断后的前10年似乎尤为重要。
