Skip to main content
SpringerLink
Log in

Does a safe size-limit exist for unruptured intracranial aneurysms?

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Of 1076 patients with intracranial ruptured aneurysms (RA) included in the Danish Aneurysm Study, 948 had the RA verified by angiography. Of these cases 908 RA had a maximum diameter less than 25 mm. 162 RA were <5 mm, 474 and 272 were between 5–10 mm and 11–24 mm, respectively. The average diameter of the RA according to the day of angiography after the aneurysm rupture did not differ significantly within the first 10 days. In these circumstances, using this indirect method for estimation of aneurysm rupture according to the size, we also recommend that unruptured aneurysms with a size 10 mm or less should be seriously considerated for operation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

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

    PubMed  Google Scholar 

  2. Auer LM (1991) Unfavourable outcome following early surgical repair of ruptured cerebral aneurysms — a critical review of 238 patients. Surg Neurol 35: 152–158

    PubMed  Google Scholar 

  3. Bailes JE, Spetzler RF, Hadley MN,et al (1990) Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72: 559–566

    PubMed  Google Scholar 

  4. Bonita R, Thomson S (1985) Subarachnoid haemorrhage: epidemiology, diagnosis, management, and outcome. Stroke 4: 591–594

    Google Scholar 

  5. de Boulay GH (1965) Some observations on the natural history of intracranial aneurysms. Br J Radiol 38: 721–757

    PubMed  Google Scholar 

  6. van Crevel H, Habbema JDF, Braakman R (1986) Decision analysis of the management of incidental intracranial saccular aneurysms. Neurology 36: 1335–1339

    PubMed  Google Scholar 

  7. Cromptom MR (1966) Mechanism of growth and rupture in cerebral berry aneurysms. Br Med J 1: 1138–1142

    Google Scholar 

  8. Dell S (1982) Asymptomatic cerebral aneurysm: assessment of its risk of rupture. Neurosurgery 10: 162–166

    PubMed  Google Scholar 

  9. Dion J, Gates P, Fox AJ,et al (1986) Clinical events following neuroangiography. Acta Radiol [Suppl] (Stockh) 369: 29–33

    Google Scholar 

  10. Drake CG, Girvin JP (1976) The surgical treatment of subarachnoid haemorrhage with multiple aneurysms. In: Morley TP (ed) Current controversies in neurosurgery. Saunders, Philadelphia, pp 274–278

    Google Scholar 

  11. Drake CG (1981) Management of cerebral aneurysms. Stroke 3: 273–283

    Google Scholar 

  12. Earnest F, Forbes G, Sandok B,et al (1984) Complications of cerebral angiography: prospective assessment of risk. AJR 142: 247–253

    PubMed  Google Scholar 

  13. Eskesen V, Rosenørn J, Schmidt K,et al (1987) Clinical features and outcome in 48 patients with unruptured intracranial saccular aneurysms: a prospective consecutive study. Br J Neurosurg 1: 47–52

    PubMed  Google Scholar 

  14. Eskesen V, Rosenørn J, Schmidt K (1988) The influence of unruptured intracranial aneurysms on life expectancy in relation to their size at the time of detection and age. Br J Neurosurg 2: 379–384

    PubMed  Google Scholar 

  15. Eskesen V, Rosenørn J, Schmidt K (1989) The size of ruptured intracranial aneurysms. In: Bhatia R, Bhatia S (eds) Book of abstracts of 9th International Congress of Neurological Surgery. New Delhi, p 48

  16. Ferguson GG (1972) Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 37: 666–667

    PubMed  Google Scholar 

  17. Fogelholm R (1981) Subarachnoid haemorrhage in Middle-Finland: incidence, early prognosis, and indications for neurosurgical treatment. Stroke 3: 296–301

    Google Scholar 

  18. Garraway WM, Whisnant JP, Furlan AJ,et al (1979) The declining incidence of stroke. N Engl J Med 300: 449–452

    PubMed  Google Scholar 

  19. Graf CJ (1971) Prognosis for patients with nonsurgically treated aneurysms. Analysis of the co-operative study of intracranial aneurysms and subarachnoid haemorrhage. J Neurosurg 35: 438–443

    PubMed  Google Scholar 

  20. Hashimoto N, Handa H (1983) The size of cerebral aneurysms in relation to repeated rupture. Surg Neurol 19: 107–111

    PubMed  Google Scholar 

  21. Hauerberg J, Andersen BB, Eskesen V,et al (1991) Importance of the recognition of a warning leak as a sign of a ruptured intracranial aneurysm. Acta Neurol Scand 83: 61–64

    PubMed  Google Scholar 

  22. Heiskanen O, Marttila I (1970) Risk of rupture of a second aneurysm in patients with multiple aneurysms. J Neurosurg 32: 295–299

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  24. Heiskanen O (1986) Risks of surgery for unruptured intracranial aneurysms. J Neurosurg 65: 451–453

    PubMed  Google Scholar 

  25. Hijdra A, Braakman R, van Gijn J,et al (1987) Aneurysmal subarachnoid haemorrhage. Complications and outcome in a hospital population. Stroke 18: 1061–1067

    PubMed  Google Scholar 

  26. Jane JA, Kassell NF, Torner JC,et al (1985) The natural history of aneurysms and arteriovenous malformations. J Neurosurg 62: 321–323

    PubMed  Google Scholar 

  27. Jomin M, Lesion F, Lozes G (1984) Prognosis with 500 ruptured and operated intracranial aneurysms. Surg Neurol 21: 13–18

    PubMed  Google Scholar 

  28. Kassell NF, Drake CG (1982) Timing of aneurysm surgery. Neurosurgery 10: 514–519

    PubMed  Google Scholar 

  29. Kassell NF, Torner JC (1983) Size of intracranial aneurysms. Neurosurgery 12: 291–297

    PubMed  Google Scholar 

  30. Kassell NF, Torner JC (1983) Aneurysmal rebleeding: a preliminary report from the cooperative aneurysm study. Neurosurgery 5: 479–481

    Google Scholar 

  31. Kassell NF, Torner JC, Haley EC Jr,et al (1990) The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg 73: 18–36

    PubMed  Google Scholar 

  32. Kassell NF, Torner JC, Jane JA,et al (1990) The international cooperative study on the timing of aneurysm surgery. Part 2: Surgical results. J Neurosurg 73: 37–47

    PubMed  Google Scholar 

  33. Kristensen MØ (1983) Increased incidence of bleeding intracranial aneurysms in Greenlandic Eskimos. Acta Neurochir (Wien) 67: 37–43

    Google Scholar 

  34. Ljunggren B, Säveland H, Brandt L,et al (1985) Early operation and overall outcome in aneurysmal subarachnoid haemorrhage. J Neurosurg 62: 547–551

    PubMed  Google Scholar 

  35. Locksley HB (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid haemorrhage. Section V, part II. Natural history of subarachnoid haemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg 25: 321–368

    PubMed  Google Scholar 

  36. McCaughey WTE (1956) Ruptured intracranial aneurysms. Ulster Med J 25: 111–118

    PubMed  Google Scholar 

  37. Marttila I, Heiskanen O (1970) Value of neurological and angiographic signs as indicators of the ruptured aneurysm in patients with multiple intracranial aneurysms. Acta Neurochir (Wien) 23: 95–102

    Google Scholar 

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

    PubMed  Google Scholar 

  39. Mount LA, Brisman R (1974) Treatment of multiple aneurysms — symptomatic and asymptomatic. Clin Neurosurg 21: 166–170

    PubMed  Google Scholar 

  40. Ojemann RG (1981) Management of the unruptured intracranial aneurysm. N Engl J Med 304: 725–726

    PubMed  Google Scholar 

  41. Olivecrona H (1977) Complications of cerebral angiography. Neuroradiology 14: 175–181

    PubMed  Google Scholar 

  42. Pakarinen S (1967) Incidence, aetiology, and prognosis of primary subarachnoid haemorrhage: a study based on 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand 43 [Suppl 29]: 1–128

    Google Scholar 

  43. Philips LH, Whisnant JP, O'Fallon WM,et al (1980) The unchanging pattern of subarachnoid haemorrhage in a community. Neurology 30: 1034–1040

    PubMed  Google Scholar 

  44. Rosenørn J, Astrup J, Duel P,et al (1986) The risk of haemorrhage from non-ruptured sacculate intracranial aneurysms. J Danish Med Ass 148: 3363–3365 [English summary]

    Google Scholar 

  45. Rosenørn J, Eskesen V, Schmidt K,et al (1987) Clinical features and outcome in 1076 patients with ruptured intracranial saccular aneurysms: a prospective consecutive study. Br J Neurosurg 1: 33–46

    PubMed  Google Scholar 

  46. Rosenørn J, Eskesen V, Schmidt K,et al (1987) The risk of rebleeding from ruptured intracranial aneurysms. J Neurosurg 67: 329–332

    PubMed  Google Scholar 

  47. Rosenørn J (1988) Unfavourable prognostic factors in patients with intracranial aneurysms and the possibilities to improve the overall outcome. Prog Clin Neurosci 2: 179–186

    Google Scholar 

  48. Rosenørn J, Eskesen V, Schmidt K (1988) Unruptured intracranial aneurysms: an assessment of the annual risk of rupture based on epidemiological and clinical data. Br J Neurosurg 2: 369–378

    PubMed  Google Scholar 

  49. Rosenørn J, Eskesen V, Madsen F,et al (1993) The importance of cerebral pan-angiography for detection of multiple aneurysms in patients with aneurysmal subarachnoid haemorrhage. Acta Neurol Scand (accepted)

  50. Säveland H, Hillman J, Brandt L,et al (1992) Overall outcome in aneurysmal subarachnoid haemorrhage. J Neurosurg 76: 729–734

    PubMed  Google Scholar 

  51. Salazar JL (1980) Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 53: 20–21

    PubMed  Google Scholar 

  52. Samson DS, Hodosh RM, Clark WK (1977) Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46: 731–734

    PubMed  Google Scholar 

  53. Sarwar M, Batnitzky S, Schreckter MM,et al (1976) Growing intracranial aneurysms. Radiology 120: 603–607

    PubMed  Google Scholar 

  54. Seiler RW, Reulen HJ, Huber P,et al (1988) Outcome of aneurysmal subarachnoid haemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine, and transcranial Doppler ultrasound. Neurosurgery 23: 598–604

    PubMed  Google Scholar 

  55. Solomon RA, Fink ME, Lennihan L (1988) Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid haemorrhage. Neurosurgery 23: 699–704

    PubMed  Google Scholar 

  56. Stehbens WE (1963) Aneurysms and anatomical variations of cerebral arteries. Arch Pathol 75: 45–64

    PubMed  Google Scholar 

  57. Sundt TM, Kobayashi S, Fode NC,et al (1982) Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. J Neurosurg 56: 753–765

    PubMed  Google Scholar 

  58. Suzuki J, Ohara H (1978) Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth. J Neurosurg 48: 505–514

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  60. Winn HR, Almaani WS, Berga SL,et al (1983) The long-term outcome in patients with multiple aneurysms. J Neurosurg 59: 642–651

    PubMed  Google Scholar 

  61. Wirth FP, Laws ER, Piepgras DS (1983) Surgical treatment of incidental intracranial aneurysms. Neurosurgery 12: 507–511

    PubMed  Google Scholar 

  62. Wood EH (1964) Angiographic identification of the ruptured lesion in patients with multiple cerebral aneurysms. J Neurosurg 21: 182–198

    PubMed  Google Scholar 

  63. Zacks DJ, Russell DB, Miller JDR (1980) Fortuitously discovered intracranial aneurysms. Arch Neurol 37: 39–41

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Clinic of Neurosurgery, Copenhagen County Hospital, Glostrup, Denmark

    J. Rosenørn & V. Eskesen

Authors
  1. J. Rosenørn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Eskesen
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rosenørn, J., Eskesen, V. Does a safe size-limit exist for unruptured intracranial aneurysms?. Acta neurochir 121, 113–118 (1993). https://doi.org/10.1007/BF01809260

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01809260

Keywords

Search

Navigation