Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry

BACKGROUND AND OBJECTIVES: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms.

METHODS: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge.

RESULTS: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days).

CONCLUSION: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.

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Work Title Safety and Efficacy of Tiny (≤3 mm) Unruptured Middle Cerebral Artery Aneurysm Treatment: An Analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database Cerebral Aneurysm Registry
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Open Access
Creators
  1. Varun Padmanaban
  2. Thaddeus Harbaugh
  3. Junjia Zhu
  4. Shouhao Zhou
  5. Sameer A. Ansari
  6. Jay U. Howington
  7. Daniel H. Sahlein
  8. Juan G. Tejada
  9. D. Andrew Wilkinson
  10. Scott D. Simon
  11. Kevin M. Cockroft
  12. Ephraim W. Church
Keyword
  1. Unruptured cerebral aneurysm
  2. Subarachnoid hemorrhage
  3. Surgical complications
  4. Small cerebral aneurysms
  5. Middle cerebral artery aneurysms
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Neurosurgery
Publication Date November 21, 2024
Publisher Identifier (DOI)
  1. https://doi.org/10.1227/neu.0000000000003283
Deposited March 04, 2025

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  • Created

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added safety_and_efficacy_of_tiny___3_mm__unruptured.1451.pdf

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Varun Padmanaban

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Thaddeus Harbaugh

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Junjia Zhu

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Shouhao Zhou

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Sameer A. Ansari

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Jay U. Howington

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Daniel H. Sahlein

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Juan G. Tejada

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator D. Andrew Wilkinson

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Scott D. Simon

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Kevin M. Cockroft

    March 04, 2025 16:46 by Researcher Metadata Database

  • Added Creator Ephraim W. Church

    March 04, 2025 16:46 by Researcher Metadata Database

  • Published

    March 04, 2025 16:46 by Researcher Metadata Database

  • Updated

    March 04, 2025 21:05 by [unknown user]

  • Updated Keyword, Description, Publication Date Show Changes

    March 05, 2025 11:25 by avs5190

    Keyword
    • Unruptured cerebral aneurysm, Subarachnoid hemorrhage, Surgical complications, Small cerebral aneurysms, Middle cerebral artery aneurysms
    Description
    • BACKGROUND AND OBJECTIVES: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. METHODS: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge. RESULTS: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days). CONCLUSION: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.
    • BACKGROUND AND OBJECTIVES: Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms.
    • METHODS: The NeuroVascular Quality Initiative-Quality Outcomes Database registry was queried for patients with tiny unruptured MCA aneurysms who underwent treatment. Tiny size was defined as an aneurysm with a maximum dimension of ≤3 mm. Demographics, aneurysm characteristics, and treatment safety were queried. Outcomes included modified Rankin Score (mRS) at discharge and the last follow-up as well as aneurysm occlusion status at discharge.
    • RESULTS: Of 674 treated, unruptured MCA aneurysms, 57 (8.5%) were tiny. The mean aneurysm width was 2.2 mm, and the mean patient age was 55.9 years. Most aneurysms were treated with microsurgery (61.4%, 35/57). The overall intraoperative complication rate was 5.3% (3/57), and the postoperative complication rate was 10.5% (6/57). 10.5% (6/57) of patients were discharged to rehabilitation. At discharge, 42 (87.5%) of the treated aneurysms had complete occlusion. In the subgroup of patients with recorded follow-up data, 48.3% (14/29) had a mRS of 0 at discharge and 46.9% (15/32) had an mRS of 0 at the last follow-up (median follow-up 166 days).
    • CONCLUSION: Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.
    Publication Date
    • 2024-01-01
    • 2024-11-21