title: Natural history and outcome after treatment of unruptured intradural fusiform aneurysms.
abstract: OBJECTIVE
  Management of unruptured fusiform intracranial aneurysms is controversial because of the paucity of natural history data. We studied their natural history and outcome after treatment.
  
  
  METHODS
  We reviewed our neurovascular database from January 2000 to October 2013. Inclusion criteria were unruptured, intradural fusiform aneurysms with a diameter of <2.5 cm. Criteria were developed to define atherosclerotic aneurysms. For outcome assessment, we used the modified Ranking Scale and aneurysm measurements on serial imaging. Mann-Whittney (continuous) and Fisher exact (categorical) tests were used for risk factor analysis.
  
  
  RESULTS
  For nonatherosclerotic aneurysms (96 patients; 193 person-years follow-up), 1 patient died (rupture) during follow-up (mortality, 0.51% per year) and 8 patients (10%) showed aneurysm progression (risk, 1.6% per year). Risk factors for progression were maximum diameter (>7 mm; odds ratio, 12; 95% confidence interval, 1.4-104) and symptomatic clinical presentation (odds ratio, 16; 95% confidence interval, 3.1-81.4). Of the 23 treated patients, 3 had died (mortality, 12.5%) and 3 had serious disability (modified Ranking Scale, ≥3; 12.5%). For the atherosclerotic aneurysms (25 patients; 97 person-years follow-up), 5 had died (mortality, 5.2% per year) and 13 of 20 (65%) had aneurysm progression (risk, 12% per year). When compared with patients with nonatherosclerotic aneurysms, case fatality (odds ratio, 19.2; 95% confidence interval, 2.1-172) and aneurysm progression (odds ratio, 17.8; 95% confidence interval, 5.3-56) were higher.
  
  
  CONCLUSIONS
  Nonatherosclerotic fusiform intradural aneurysms have a low risk of adverse outcome within the first few years after diagnosis and remain stable unless symptomatic on presentation or >7 mm in maximum diameter. High risks of treatment should be balanced against this benign natural history. Atherosclerotic aneurysms have a worse natural history and may represent a different disease entity.
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.). Raphael.Sacho@uhn.ca.
authors.forename: Raphael H
authors.initials: RH
authors.lastname: Sacho
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Guillaume
authors.initials: G
authors.lastname: Saliou
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Alex
authors.initials: A
authors.lastname: Kostynskyy
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Ravi
authors.initials: R
authors.lastname: Menezes
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Michael
authors.initials: M
authors.lastname: Tymianski
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Ivan
authors.initials: I
authors.lastname: Radovanovic
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Karel
authors.initials: K
authors.lastname: Terbrugge
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.affiliation: From the Departments of Interventional Neuroradiology (R.H.S., G.S., A.K., R.M., T.K., K.T., R.W.) and Neurosurgery (R.H.S., M.T., I.R.), University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada; and Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands (G.J.E.R.).
authors.forename: Robert
authors.initials: R
authors.lastname: Willinsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: asymptomatic diseases; atherosclerosis; fusiform aneurysm; natural history