OBJECTIVE: The management of unruptured intracranial aneurysms (UIA) is complex, balancing the risks of surgical intervention against aneurysm rupture. The PHASES, ELAPSS, and UIATS scoring systems have been developed to assist in clinical decision-making, but their efficacy in predicting surgical outcome remains unclear. METHODS: In this monocentric, retrospective, observational study, we included 380 patients with UIA from January 2010 to January 2021. We assessed the predictive value of the PHASES, ELAPSS, and UIATS scores in determining clinical outcome post-surgery, including different variables. Statistical analyses, including Principal Component Analysis and Multiple logistic and linear regression, were employed to analyze the data. RESULTS: Our cohort of 380 predominantly female patients (71.3%) had a mean age of 54.7 years. The PHASES and UIATS pro-conservative scores were significant predictors of poor clinical outcome (p = 0.03 and p = 0.04, respectively), while the ELAPSS score was predictive of new neurological deficits post-surgery (p = 0.01). Aneurysm size was significantly associated with new neurological deficits but not with long-term clinical performance/outcome. CONCLUSIONS: The study underscores the utility of PHASES, ELAPSS, and UIATS scores in preoperative risk stratifications. Conservative PHASES and UIATS scores were associated with poor outcome, therefore supporting their predictive value of non-operative management. Our findings suggest the routine implementation of these scores into clinical practice could improve the management of UIAs.

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Neurosurgery Medical University Innsbruck Tyrol Austria

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Thompson BG, Brown RD, Amin-Hanjani S et al (2015) Guidelines for the management of patients with unruptured intracranial aneurysms: A guideline for healthcare professionals from the American heart association/american stroke association. Stroke Aug 46(8):2368–2400. 10.1161/STR.0000000000000070 PubMed

Molyneux A, Kerr R, Stratton I et al (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet Oct 26(9342):1267–1274. 10.1016/s0140-6736(02)11314-6 PubMed

Rinkel GJ, Djibuti M, Algra A, van Gijn J (1998) Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke Jan 29(1):251–256. 10.1161/01.str.29.1.251 PubMed

Staartjes VE, Sebök M, Blum PG et al (2020) Development of machine learning-based preoperative predictive analytics for unruptured intracranial aneurysm surgery: a pilot study. Acta Neurochir (Wien) Nov 162(11):2759–2765. 10.1007/s00701-020-04355-0 PubMed

Greving JP, Wermer MJ, Brown RD et al (2014) Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol Jan 13(1):59–66. 10.1016/S1474-4422(13)70263-1 PubMed

Backes D, Rinkel GJ, Laban KG, Algra A, Vergouwen MD (2016) Patient- and aneurysm-Specific risk factors for intracranial aneurysm growth: A systematic review and Meta-Analysis. Stroke Apr 47(4):951–957. 10.1161/STROKEAHA.115.012162 PubMed

Etminan N, Brown RD, Beseoglu K et al (2015) The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus. Neurology Sep 08(10):881–889. 10.1212/WNL.0000000000001891 PubMed PMC

Feghali J, Gami A, Caplan JM, Tamargo RJ, McDougall CG, Huang J (2021) Management of unruptured intracranial aneurysms: correlation of UIATS, ELAPSS, and PHASES with referral center practice. Neurosurg Rev Jun 44(3):1625–1633. 10.1007/s10143-020-01356-6 PubMed

Liu Q, Yang Y, Yang J et al (2021) Rebleeding of ruptured intracranial aneurysm after admission: A multidimensional nomogram model to risk assessment. Front Aging Neurosci 13:692615. 10.3389/fnagi.2021.692615 PubMed PMC

Algra AM, Lindgren A, Vergouwen MDI et al (2019) Procedural clinical complications, Case-Fatality risks, and risk factors in endovascular and neurosurgical treatment of unruptured intracranial aneurysms: A systematic review and Meta-analysis. JAMA Neurol Mar 01(3):282–293. 10.1001/jamaneurol.2018.4165 PubMed PMC

Hügli S, Staartjes VE, Sebök M, Blum PG, Regli L, Esposito G (2023) Differences between real-world and score-based decision-making in the microsurgical management of patients with unruptured intracranial aneurysms. J Neurosurg Sci Jun 12. 10.23736/S0390-5616.23.06038-1 PubMed