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Publications

Journal Article Ahead of print

PubMed: 42414088 DOI: 10.1136/jnnp-2026-338459

Clinical outcomes of conservative, endovascular and microsurgical management of unruptured giant intracranial aneurysms: 3-year follow-up of the prospective, multinational Giant Intracranial Aneurysm Registry.

J Neurol Neurosurg Psychiatry

Authors: Lars Wessels, Kiarash Ferdowssian, Julius Dengler, Lukas Mödl, Erin D Sprünken, Marco Cenzato, Edoardo Boccardi, Luca Regli, Christophe Cognard, Ruben Dammers, Mika Niemelä, Lasse Dührsen, Joachim K Krauss, Karl Schaller, Philippe Bijlenga, Wei-Te Wang, Stefan A Rath, Italo Linfante, Karl-Michael Schebesch, Nils O Schmidt, Ralph W König, Naoki Kato, Jürgen Beck, Ulrich Sure, Karsten H Wrede, Serge Marbacher, Johannes Lemcke, Hans J Meisel, Matthias Endres, Bernhard Meyer, Veit Rohde, Daniel A Rüfenacht, Peter Vajkoczy

Affiliations

  • Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
  • Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Department of Neurosurgery, Ospedale Niguarda Ca' Granda, Milano, Italy.
  • Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy.
  • Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
  • Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
  • Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands.
  • Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
  • Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany.
  • Department Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
  • Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland.
  • Neurosurgery Division, Geneva University Hospitals, Geneva, Switzerland.
  • Department of Neurosurgery, Vienna General Hospital, Vienna, Austria.
  • Department of Neurosurgery, Spine Surgery and Interventional Neuroradiology, DONAUISAR Klinikum Deggendorf-Dingolfing-Landau, Deggendorf, Germany.
  • Department of Neurosurgery, University Hospital Rechts der Isar, Munich, Germany.
  • Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany.
  • Department of Neurosurgery, Ulm University Hospital, Ulm, Germany.
  • Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
  • Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
  • Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
  • Centre for Neuroradiology, Clinic Hirslanden, Zurich, Switzerland.
  • Department of Neurosurgery, Berufsgenossenschaftliche Kliniken Bergmannstrost Halle, Halle, Germany.
  • Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Abstract

BACKGROUND

Evidence regarding the clinical course of unruptured giant intracranial aneurysms (GIAs) after conservative management (CON), microsurgical treatment (SURG) or endovascular treatment (EVT) remains limited. We aimed to assess mortality, functional outcome, symptom course and retreatment rates after different management strategies.

METHODS

In this prospective, multinational registry, patients with unruptured GIAs treated at 37 neurovascular centres between 2008 and 2018 were included. Outcomes after CON, EVT or SURG were analysed with standardised 3-year follow-up. The study is registered at ClinicalTrials.gov.

RESULTS

We included 339 patients of whom 22.7% received CON, 42.8% EVT and 34.5% SURG. Three-year survival was 64.0% (95% CI 53.73% to 76.20%) in the CON group, 82.0% (95% CI 75.42% to 89.17%) in the EVT group and 93.5% (95% CI 88.91% to 98.28%) in the SURG group (p<0.001). Favourable neurological outcome (modified Rankin Scale 0-2) declined to 53.0%, 66.9% and 75.7% in the CON, EVT and SURG groups, respectively (p<0.01). Symptom improvement at 3 years occurred in 10.3% of CON, 22.1% of EVT and 11.1% of SURG patients, while deterioration was observed in 7.7%, 8.5% and 15.8%, respectively. Retreatment was required in 22.8% of EVT patients and 6.2% of SURG patients (p<0.01).

CONCLUSIONS

EVT and SURG were associated with significantly improved survival and functional outcomes compared with conservative management of unruptured GIAs. In patients eligible for intervention, both treatment modalities represent reasonable and effective options, with a high proportion of patients achieving favourable clinical outcomes.

TRIAL REGISTRATION NUMBER

NCT02066493.

MeSH

Registries, Conservative Treatment, Aneurysm, Therapeutics, Intracranial Aneurysm, Neurology