Geiger Philipp A, Preuss-Hernandez Christian, Kögl Nikolaus, Rey Jeannine, Thomé Claudius, Petr Ondra
Department of Neurosurgery, Medical University Innsbruck, Tyrol, Austria.
Department of Neurosurgery & Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
Neurosurg Rev. 2025 Jul 11;48(1):559. doi: 10.1007/s10143-025-03683-y.
The management of unruptured intracranial aneurysms (UIA) is complex, balancing the risks of surgical intervention against aneurysm rupture. The PHASES, ELAPSS, and UIATS scoring systems have been developed to assist in clinical decision-making, but their efficacy in predicting surgical outcome remains unclear.
In this monocentric, retrospective, observational study, we included 380 patients with UIA from January 2010 to January 2021. We assessed the predictive value of the PHASES, ELAPSS, and UIATS scores in determining clinical outcome post-surgery, including different variables. Statistical analyses, including Principal Component Analysis and Multiple logistic and linear regression, were employed to analyze the data.
Our cohort of 380 predominantly female patients (71.3%) had a mean age of 54.7 years. The PHASES and UIATS pro-conservative scores were significant predictors of poor clinical outcome (p = 0.03 and p = 0.04, respectively), while the ELAPSS score was predictive of new neurological deficits post-surgery (p = 0.01). Aneurysm size was significantly associated with new neurological deficits but not with long-term clinical performance/outcome.
The study underscores the utility of PHASES, ELAPSS, and UIATS scores in preoperative risk stratifications. Conservative PHASES and UIATS scores were associated with poor outcome, therefore supporting their predictive value of non-operative management. Our findings suggest the routine implementation of these scores into clinical practice could improve the management of UIAs.
未破裂颅内动脉瘤（UIA）的管理较为复杂，需要在手术干预风险与动脉瘤破裂风险之间进行权衡。已开发出PHASES、ELAPSS和UIATS评分系统以协助临床决策，但其预测手术结果的有效性仍不明确。
在这项单中心、回顾性观察研究中，我们纳入了2010年1月至2021年1月期间的380例UIA患者。我们评估了PHASES、ELAPSS和UIATS评分在确定术后临床结果（包括不同变量）方面的预测价值。采用包括主成分分析、多元逻辑回归和线性回归在内的统计分析方法对数据进行分析。
我们的380例患者队列中，女性占主导（71.3%），平均年龄为54.7岁。PHASES和UIATS的保守评分是临床结果不佳的显著预测因素（分别为p = 0.03和p = 0.04），而ELAPSS评分可预测术后新出现的神经功能缺损（p = 0.01）。动脉瘤大小与新出现的神经功能缺损显著相关，但与长期临床表现/结果无关。
该研究强调了PHASES、ELAPSS和UIATS评分在术前风险分层中的作用。PHASES和UIATS的保守评分与不良结果相关，因此支持它们对非手术治疗的预测价值。我们的研究结果表明，将这些评分常规应用于临床实践可改善UIA的管理。
