Risk stratification and treatment outcomes after surgical treatment of 0unruptured intracranial aneurysms: a single-center retrospective review

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Abstract Purpose Management of unruptured intracranial aneurysms (UIAs) requires weighing rupture risk against treatment risk. As endovascular techniques have evolved, microsurgical intervention has become increasingly concentrated at high-volume centers and reserved for complex cases, potentially representing a higher-risk endeavor than reflected in earlier series. A contemporary evaluation of patient and aneurysm-related features associated with surgical risk and postoperative outcomes is needed. Methods We conducted a single-centre retrospective review of 404 UIAs across 347 patients treated between 1998–2024 at TWH. Demographics, aneurysm characteristics, treatment details, and functional outcome (modified Rankin Scale [mRS] at 4–6 weeks) were recorded. Multivariable Firth penalized logistic regression identified factors associated with postoperative dependency (mRS ≥ 3). Results Aneurysm size greater than 1 cm was independently associated with worse postoperative outcomes (OR 2.4, 95% CI 1.2–4.8, p = 0.013), irrespective of morphology, location, or comorbidity. Minimally invasive craniotomies correlated with shorter hospital stays (2.5 ± 1.5 vs 4.4 ± 2.9 days) and lower dependency rates (2.4% vs 17.0%, p < 0.001) than standard craniotomies. Bypass procedures (27 cases) carried greater stroke rates (29.6% vs 6.4%, p < 0.001) and poorer outcomes (22.2% vs 6.4%, p = 0.01) than clipping. Overall mortality was 2.0%. Conclusions Among surgically treated UIAs, size > 1 cm was associated with functional dependency, irrespective of location, morphology, or comorbidities, while most aneurysms under 1 cm remained functionally independent regardless of other factors. These findings provide a contemporary, risk-stratified framework to guide patient selection and multidisciplinary counselling.