Natural history of unruptured intracranial aneurysms: a long-term follow-up study

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  • 1 Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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✓ To investigate the natural history of unruptured aneurysms and predictive risk factors determining subsequent rupture, the authors followed 142 patients with 181 unruptured aneurysms until death or subarachnoid hemorrhage intervened, or for at least 10 years after the unruptured aneurysm was diagnosed. Six patients had a symptomatic aneurysm, five had an incidentally discovered aneurysm, and 131 had multiple aneurysms, of which the ruptured lesion was clipped at the beginning of the follow-up study. The median follow-up time was 13.9 years (range 0.8 to 30.0 years). During 1944 patient-years of follow-up study there were 27 first episodes of hemorrhage from a previously unruptured aneurysm, giving an average annual rupture incidence of 1.4%. Fourteen of these bleeding episodes were fatal. The cumulative rate of bleeding was 10% at 10 years, 26% at 20 years, and 32% at 30 years after the diagnosis.

The only predictor for the rupture was the size of the aneurysm (p = 0.036). However, in patients with multiple aneurysms (the main subgroup) the only variable that tended to predict rupture was the age of the patient: risk of rupture was inversely associated with age (p = 0.080). The median diameter of the aneurysms was 4 mm at the beginning of the follow-up period, both in those with and those without a later hemorrhage. During the angiographic monitoring period, a ruptured aneurysm significantly (p < 0.001) increased in size in 17 patients with hemorrhage but aneurysms did not increase significantly in 14 patients without hemorrhage. In addition, a new aneurysm was found in six of 31 patients. The authors conclude that an unruptured aneurysm should be operated on, irrespective of its size, if it is technically possible and the patient's age and concurrent diseases are not contraindications to surgery.

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Contributor Notes

Address reprint requests to: Seppo Juvela, M.D., Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, SF-00260 Helsinki 26, Finland.
  • 1.

    Allcock JM, & Canham PB: Angiographic study of the growth of intracranial aneurysms. J Neurosurg 45:617621, 1976 Allcock JM, Canham PB: Angiographic study of the growth of intracranial aneurysms. J Neurosurg 45:617–621, 1976

    • Search Google Scholar
    • Export Citation
  • 2.

    Andrews RJ, & Spiegel PK: Intracranial aneurysms. Age, sex, blood pressure, and multiplicity in an unselected series of patients. J Neurosurg 51:2732, 1979 Andrews RJ, Spiegel PK: Intracranial aneurysms. Age, sex, blood pressure, and multiplicity in an unselected series of patients. J Neurosurg 51:27–32, 1979

    • Search Google Scholar
    • Export Citation
  • 3.

    Atkinson JLD, , Sundt TM Jr, & Houser OW, et al: Angiographic frequency of anterior circulation intracranial aneurysms. J Neurosurg 70:551555, 1989 Atkinson JLD, Sundt TM Jr, Houser OW, et al: Angiographic frequency of anterior circulation intracranial aneurysms. J Neurosurg 70:551–555, 1989

    • Search Google Scholar
    • Export Citation
  • 4.

    Ferguson GG: Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 37:666677, 1972 Ferguson GG: Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 37:666–677, 1972

    • Search Google Scholar
    • Export Citation
  • 5.

    Heiskanen O: Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55:524526, 1981 Heiskanen O: Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55:524–526, 1981

    • Search Google Scholar
    • Export Citation
  • 6.

    Heiskanen O: Risks of surgery for unruptured intracranial aneurysms. J Neurosurg 65:451453, 1986 Heiskanen O: Risks of surgery for unruptured intracranial aneurysms. J Neurosurg 65:451–453, 1986

    • Search Google Scholar
    • Export Citation
  • 7.

    Heiskanen O, , Poranen A, & Kuurne T, et al: Acute surgery for intracerebral haematomas caused by rupture of an intracranial arterial aneurysm. A prospective randomized study. Acta Neurochir 90:8183, 1988 Heiskanen O, Poranen A, Kuurne T, et al: Acute surgery for intracerebral haematomas caused by rupture of an intracranial arterial aneurysm. A prospective randomized study. Acta Neurochir 90:81–83, 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Inagawa T: Follow-up study of unruptured aneurysms arising from the C3 and C4 segments of the internal carotid artery. Surg Neurol 36:99105, 1991 Inagawa T: Follow-up study of unruptured aneurysms arising from the C3 and C4 segments of the internal carotid artery. Surg Neurol 36:99–105, 1991

    • Search Google Scholar
    • Export Citation
  • 9.

    Inagawa T: Multiple intracranial aneurysms in elderly patients. Acta Neurochir 106:119126, 1990 Inagawa T: Multiple intracranial aneurysms in elderly patients. Acta Neurochir 106:119–126, 1990

    • Search Google Scholar
    • Export Citation
  • 10.

    Inagawa T: Surgical treatment of multiple intracranial aneurysms. Acta Neurochir 108:2229, 1991 Inagawa T: Surgical treatment of multiple intracranial aneurysms. Acta Neurochir 108:22–29, 1991

    • Search Google Scholar
    • Export Citation
  • 11.

    Inagawa T, & Hirano A: Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 34:361365, 1990 Inagawa T, Hirano A: Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 34:361–365, 1990

    • Search Google Scholar
    • Export Citation
  • 12.

    Iwata K, , Misu N, & Terada K, et al: Screening for unruptured asymptomatic intracranial aneurysms in patients undergoing coronary angiography. J Neurosurg 75:5255, 1991 Iwata K, Misu N, Terada K, et al: Screening for unruptured asymptomatic intracranial aneurysms in patients undergoing coronary angiography. J Neurosurg 75:52–55, 1991

    • Search Google Scholar
    • Export Citation
  • 13.

    Jane JA, , Kassell NF, & Tomer JC, et al: The natural history of aneurysms and arteriovenous malformations. J Neurosurg 62:321323, 1985 Jane JA, Kassell NF, Tomer JC, et al: The natural history of aneurysms and arteriovenous malformations. J Neurosurg 62:321–323, 1985

    • Search Google Scholar
    • Export Citation
  • 14.

    Juvela S: Alcohol consumption as a risk factor for poor outcome after aneurysmal subarachnoid haemorrhage. BMJ 304:16631667, 1992 Juvela S: Alcohol consumption as a risk factor for poor outcome after aneurysmal subarachnoid haemorrhage. BMJ 304:1663–1667, 1992

    • Search Google Scholar
    • Export Citation
  • 15.

    Juvela S: Minor leak before rupture of an intracranial aneurysm and subarachnoid hemorrhage of unknown etiology. Neurosurgery 30:711, 1992 Juvela S: Minor leak before rupture of an intracranial aneurysm and subarachnoid hemorrhage of unknown etiology. Neurosurgery 30:7–11, 1992

    • Search Google Scholar
    • Export Citation
  • 16.

    Juvela S: Platelet aggregation and thromboxane release in primary subarachnoid hemorrhage. Helsinki, Finland: University of Helsinki, 1991, pp 534 (Dissertation) Juvela S: Platelet aggregation and thromboxane release in primary subarachnoid hemorrhage. Helsinki, Finland: University of Helsinki, 1991, pp 5–34 (Dissertation)

    • Search Google Scholar
    • Export Citation
  • 17.

    Longstreth WT Jr, , Koepsell TD, & Yerby MS, et al: Risk factors for subarachnoid hemorrhage. Stroke 16:377385, 1985 Longstreth WT Jr, Koepsell TD, Yerby MS, et al: Risk factors for subarachnoid hemorrhage. Stroke 16:377–385, 1985

    • Search Google Scholar
    • Export Citation
  • 18.

    McCormick WF, & Acosta-Rua GJ: The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 33:422427, 1970 McCormick WF, Acosta-Rua GJ: The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 33:422–427, 1970

    • Search Google Scholar
    • Export Citation
  • 19.

    McCormick WF, & Schmalstieg EJ: The relationship of arterial hypertension to intracranial aneurysms. Arch Neurol 34:285287, 1977 McCormick WF, Schmalstieg EJ: The relationship of arterial hypertension to intracranial aneurysms. Arch Neurol 34:285–287, 1977

    • Search Google Scholar
    • Export Citation
  • 20.

    Misra BK, , Whittle IR, & Steers AJW, et al: De novo saccular aneurysms. Neurosurgery 23:1015, 1988 Misra BK, Whittle IR, Steers AJW, et al: De novo saccular aneurysms. Neurosurgery 23:10–15, 1988

    • Search Google Scholar
    • Export Citation
  • 21.

    Norrgård Ö, , Ängquist KA, & Fodstad H, et al: Intracranial aneurysms and heredity. Neurosurgery 20:236239, 1987 Norrgård Ö, Ängquist KA, Fodstad H, et al: Intracranial aneurysms and heredity. Neurosurgery 20:236–239, 1987

    • Search Google Scholar
    • Export Citation
  • 22.

    Østergaard JR: Risk factors in intracranial saccular aneurysms. Aspects on the formation and rupture of aneurysms, and development of cerebral vasospasm. Acta Neurol Scand 80:8198, 1989 Østergaard JR: Risk factors in intracranial saccular aneurysms. Aspects on the formation and rupture of aneurysms, and development of cerebral vasospasm. Acta Neurol Scand 80:81–98, 1989

    • Search Google Scholar
    • Export Citation
  • 23.

    Østergaard JR, & Høg E: Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 63:4955, 1985 Østergaard JR, Høg E: Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 63:49–55, 1985

    • Search Google Scholar
    • Export Citation
  • 24.

    Rice BJ, , Peerless SJ, & Drake CG: Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg 73:165173, 1990 Rice BJ, Peerless SJ, Drake CG: Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg 73:165–173, 1990

    • Search Google Scholar
    • Export Citation
  • 25.

    Sarti C, , Tuomilehto J, & Salomaa V, et al: Epidemiology of subarachnoid hemorrhage in Finland from 1983 to 1985. Stroke 22:848853, 1991 Sarti C, Tuomilehto J, Salomaa V, et al: Epidemiology of subarachnoid hemorrhage in Finland from 1983 to 1985. Stroke 22:848–853, 1991

    • Search Google Scholar
    • Export Citation
  • 26.

    Shinton R, & Beevers G: Meta-analysis of relation between cigarette smoking and stroke. BMJ 298:789794, 1989 Shinton R, Beevers G: Meta-analysis of relation between cigarette smoking and stroke. BMJ 298:789–794, 1989

    • Search Google Scholar
    • Export Citation
  • 27.

    Stehbens WE: Etiology of intracranial berry aneurysms. J Neurosurg 70:823831, 1989 Stehbens WE: Etiology of intracranial berry aneurysms. J Neurosurg 70:823–831, 1989

    • Search Google Scholar
    • Export Citation
  • 28.

    Weir B: Aneurysms Affecting the Nervous System. Baltimore: Williams & Wilkins, 1987 Weir B: Aneurysms Affecting the Nervous System. Baltimore: Williams & Wilkins, 1987

    • Search Google Scholar
    • Export Citation
  • 29.

    Wiebers DO, , Whisnant JP, & Sundt TM Jr, et al: The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:2329, 1987 Wiebers DO, Whisnant JP, Sundt TM Jr, et al: The significance of unruptured intracranial saccular aneurysms. J Neurosurg 66:23–29, 1987

    • Search Google Scholar
    • Export Citation
  • 30.

    Winn HR, , Almaani WS, & Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642651, 1983 Winn HR, Almaani WS, Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642–651, 1983

    • Search Google Scholar
    • Export Citation

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