TY - JOUR
T1 - Complex intracranial aneurysms
T2 - a DELPHI study to define associated characteristics
AU - Diana, Francesco
AU - Romoli, Michele
AU - Raz, Eytan
AU - Agid, Ronit
AU - Albuquerque, Felipe C.
AU - Arthur, Adam S.
AU - Beck, Jürgen
AU - Berge, Jerome
AU - Boogaarts, Hieronymus D.
AU - Burkhardt, Jan Karl
AU - Cenzato, Marco
AU - Chapot, René
AU - Charbel, Fady T.
AU - Desal, Hubert
AU - Esposito, Giuseppe
AU - Fifi, Johanna T.
AU - Florian, Stefan
AU - Gruber, Andreas
AU - Hassan, Ameer E.
AU - Jabbour, Pascal
AU - Jadhav, Ashutosh P.
AU - Korja, Miikka
AU - Krings, Timo
AU - Lanzino, Giuseppe
AU - Meling, Torstein R.
AU - Morcos, Jaques
AU - Mosimann, Pascal J.
AU - Nossek, Erez
AU - Pereira, Vitor Mendes
AU - Raabe, Andreas
AU - Regli, Luca
AU - Rohde, Veit
AU - Siddiqui, Adnan H.
AU - Tanikawa, Rokuya
AU - Tjoumakaris, Stavropoula I.
AU - Tomasello, Alejandro
AU - Vajkoczy, Peter
AU - Valvassori, Luca
AU - Velinov, Nikolay
AU - Walsh, Daniel
AU - Woo, Henry
AU - Xu, Bin
AU - Yoshimura, Shinichi
AU - van Zwam, Wim H.
AU - Peschillo, Simone
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2024.
PY - 2024/12
Y1 - 2024/12
N2 - 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.
AB - 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.
KW - Brain aneurysm
KW - Clipping
KW - Coiling
KW - DELPHI
KW - SAH
UR - https://www.scopus.com/pages/publications/85198048075
U2 - 10.1007/s00701-024-06182-z
DO - 10.1007/s00701-024-06182-z
M3 - Article
C2 - 38990336
AN - SCOPUS:85198048075
SN - 0001-6268
VL - 166
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 1
M1 - 294
ER -