Complex intracranial aneurysms: a DELPHI study to define associated characteristics

期刊论文
发表日期：

2024年7月11日

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Francesco Diana,
Michele Romoli,
Eytan Raz,
Ronit Agid,
Felipe C. Albuquerque,
Adam S. Arthur,
Jürgen Beck,
Jerome Berge,
Hieronymus D. Boogaarts,
Jan-Karl Burkhardt,
Marco Cenzato,
René Chapot,
Fady T. Charbel,
Hubert Desal,
Giuseppe Esposito,
Johanna T. Fifi,
Stefan Florian,
Andreas Gruber,
Ameer E. Hassan,
Pascal Jabbour,
Ashutosh P. Jadhav,
Miikka Korja,
Timo Krings,
Giuseppe Lanzino,
Torstein R. Meling,
Jaques Morcos,
Pascal J. Mosimann,
Erez Nossek,
Vitor Mendes Pereira,
Andreas Raabe,
Luca Regli,
Veit Rohde,
Adnan H. Siddiqui,
Rokuya Tanikawa,
Stavropoula I. Tjoumakaris,
Alejandro Tomasello,
Peter Vajkoczy,
Luca Valvassori,
Nikolay Velinov,
Daniel Walsh,
Henry Woo,
Bin Xu,
Shinichi Yoshimura,
Wim H. van Zwam,
Simone Peschillo

摘要

Purpose

Intracranial aneurysms present significant health risks, as their rupture leads to subarachnoid haemorrhage, which in turn has high morbidity and mortality rates. There are several elements affecting the complexity of an intracranial aneurysm. However, criteria for defining a complex intracranial aneurysm (CIA) in open surgery and endovascular treatment could differ, and actually there is no consensus on the definition of a "complex" aneurysm. This DELPHI study aims to assess consensus on variables defining a CIA.

Methods

An international panel of 50 members, representing various specialties, was recruited to define CIAs through a three-round Delphi process. The panelists participated in surveys with Likert scale responses and open-ended questions. Consensus criteria were established to determine CIA variables, and statistical analysis evaluated consensus and stability.

Results

In open surgery, CIAs were defined by fusiform or blister-like shape, dissecting aetiology, giant size (≥ 25 mm), broad neck encasing parent arteries, extensive neck surface, wall calcification, intraluminal thrombus, collateral branch from the sac, location (AICA, SCA, basilar), vasospasm context, and planned bypass (EC-IC or IC-IC). For endovascular treatment, CIAs included giant size, very wide neck (dome/neck ratio ≤ 1:1), and collateral branch from the sac.

Conclusions

The definition of aneurysm complexity varies by treatment modality. Since elements related to complexity differ between open surgery and endovascular treatment, these consensus criteria of CIAs could even guide in selecting the best treatment approach.