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25.03.2020 | Review Article - Vascular Neurosurgery - Aneurysm

Size of ruptured intracranial aneurysms: a systematic review and meta-analysis

Zeitschrift:
Acta Neurochirurgica
Autoren:
Muhammad Waqas, Felix Chin, Hamidreza Rajabzadeh-Oghaz, Andrew D. Gong, Hamid H. Rai, Maxim Mokin, Kunal Vakharia, Rimal H. Dossani, Hui Meng, Kenneth V. Snyder, Jason M. Davies, Elad I Levy, Adnan H Siddiqui
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-020-04291-z) contains supplementary material, which is available to authorized users.
Previous Presentation
Oral Presentation, Congress of Neurological Surgeons Annual Meeting, San Francisco CA, October 19-23, 2019
This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Abstract

Background

There is wide variation in the reported size of ruptured intracranial aneurysms and methods of size estimation. There is widespread belief that small aneurysms < 7 mm do not rupture. Therefore, we performed a systematic review and meta-analysis of the literature to determine the size of ruptured aneurysms according to aneurysm locations and methods of size estimation.

Methods

We searched PubMed, Cochrane, CINAHL, and EMBASE databases using a combination of Medical Subject Headings (MeSH) terms. We included articles that reported mean aneurysm size in consecutive series of ruptured intracranial. We excluded studies limited to a specific aneurysm location or type. The random-effects model was used to calculate overall mean size and location-specific mean size. We performed meta-regression to explain observed heterogeneity and variation in reported size.

Results

The systematic review included 36 studies and 12,609 ruptured intracranial aneurysms. Overall mean aneurysm size was 7.0 mm (95% confidence interval [CI 6.2–7.4]). Pooled mean size varied with location. Overall mean size of 2145 ruptured anterior circulation aneurysms was 6.0 mm (95% CI 5.6–6.4, residual I2 = 86%). Overall mean size of 743 ruptured posterior circulation aneurysms was 6.2 mm (95% CI 5.3–7.0, residual I2 = 93%). Meta-regression identified aneurysm location and definition of size (i.e., maximum dimension vs. aneurysm height) as significant determinants of aneurysm size reported in the studies.

Conclusions

The mean size of ruptured aneurysms in most studies was approximately 7 mm. The general wisdom that aneurysms of this size do not rupture is incorrect. Location and size definition were significant determinants of aneurysm size.

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