Analysis Of Management And Clinical Follow-up For Unruptured Intracranial Aneurysms

Objectives: To analyze the relationship between the management and outcome of unruptured intracranial aneurysms(UIAs) retrospectively.Methods: Between June 2006 to December 2009, a total of 81 patients with 101 UIAs were followed-up in the neurosurgical department of the first affiliated of Chongqing medical university. The mean follow-up duration was 10.2 months. All patients were diagnosed by DSA, 3-dimentional CTA or MRA; and were classified into 3 types: (1) incidental aneurysm, 23 patients with 28 aneurysms; (2) symptomatic aneurysm, 26 patients with 31 aneurysms; (3) unruptured one in multiple aneurysms, 32 patients with 46 aneurysms. The patients were managed by 3 methods: (1)surgical clipping, 19 patients with 19 aneurysms; (2)coil embolization, 11 patients with 12 aneurysms; (3)conservative observation, 53 patients with 70 aneurysms. The risk factors and the relationship between the management and outcome of UIAs had been analyzed.Results: The female has a higher prealence of UIAs than male with a proportion of 1:1.89. The involved age was between 30 and 81 years old, with a mean age of 54.58 years. The peak incidence of age was between 40 and 65 years old. The dominant UIAs were medium and small aneurysms(with a diameter of less than 15mm) at a rate of 93.4%. In the whole UIAs, 64.1% were small types (with a diameter of less than 5mm). The main sites of these UIAs were in anterior circulation system; and PcoA, other sites of internal carotid, ACA, MCA took 41.6%, 23.8%, 13.9% and 9.9% Respectively.Gender, age and size of aneurysms had no significant correlation with the natural prognosis of UIAs, while the sites and related symptoms correlated with the natural prognosis of UIAs significantly.Compare the management methods and Glasgow Outcome Score(GOS) demonstrated that the Clipping group had the best prognosis, while the conservative observation group the worst; and there was no significant difference(P=0.125).Meantime, 58 patients with 70 UIAs were followed radiologically, 14 aneurysms in the clipping group were clipped completely, one of 7 UIAs in the coil embolized group was partially embolized(>90%), and 49 UIAs in the Conservative observation group, one of which had the neck enlarged, 2 body enlarged, 5 ruptured(the size of all the ruptured aneurysms was less than 5mm). The Statistics test demonstrated that the clipping group had better outcome than the coiling group, and the conservative observation group the worst; however there was no significant difference(P=0.274).Conclusions: UIAs are mainly medium and small types, and the size of ruptured UIAs are often less than 5mm. The management of UIAs is still to be clarified. With the development of radiological technology, more and more small UIAs are certain to be detected, and that will bring a new challenge for neurologist in clinical settings.