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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Risk of rupture of unruptured cerebral aneurysms in elderly patients
Tomohito Hishikawa1, Isao Date2, Koji Tokunaga2
1From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. t-hishi@md.okayama-u.ac.jp.
Objectives:
The aim of this study was to identify risk factors for rupture of unruptured cerebral aneurysms (UCAs) in elderly Japanese patients aged 70 years or older.
Methods:
The participants included all patients 70 years of age or older in 3 prospective studies in Japan (the Unruptured Cerebral Aneurysm Study of Japan [UCAS Japan], UCAS II, and the prospective study at the Jikei University School of Medicine). A total of 1,896 patients aged 70 years or older with 2,227 UCAs were investigated. The median and mean follow-up periods were 990 and 802.7 days, respectively.
Results:
The mean aneurysm size was 6.2 ± 3.9 mm. Sixty-eight patients (3.6%) experienced subarachnoid hemorrhage during the follow-up period. Multivariable analysis per patient revealed that in patients aged 80 years or older (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.16-3.49, p = 0.012), aneurysms 7 mm or larger (HR, 3.08; 95% CI, 1.35-7.03, p = 0.007 for 7-9 mm; HR, 7.82; 95% CI, 3.60-16.98, p < 0.001 for 10-24 mm; and HR, 43.31; 95% CI, 12.55-149.42, p < 0.001 for ≥25 mm) and internal carotid-posterior communicating artery aneurysms (HR, 2.45; 95% CI, 1.23-4.88, p = 0.011) were independent predictors for UCA rupture in elderly patients.
Conclusions:
In our pooled analysis of prospective cohorts in Japan, patient age and aneurysm size and location were significant risk factors for UCA rupture in elderly patients.
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