Risk of Hemorrhage from "de novo" Cerebral Aneurysms

Daniel H. Fulkerson, MD1, William Kemp III, BS1, Troy Payner, MD1, Thomas Leipzig, MD1, Aaron Cohen-Gadol, MD, MSc1, Terry Horner, MD1

1Indianapolis, IN United States

Keywords: hemorrhage, stroke, aneurysm, risk factor, natural history

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     A small percentage of patients will develop a new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown.
     The goal of this study is to statistically analyze risk factors for rupture and to estimate a risk of subarachnoid hemorrhage (SAH) from these lesions.
     Thirty-seven patients were identified as having a total of 42 true de novo aneurysms. There was a female predominance and a high percentage of smokers. Ten of these 42 aneurysms hemorrhaged. All the de novo were less than 7 mm in size.
     A review of a prospectively maintained database of all aneurysms treated by the neurosurgery service of Goodman Campbell Brain and Spine from 1976-2010 was performed.
     The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA trial. There was a statistical difference in age, with the SAH group significantly older (p=0.047) compared to the group without hemorrhage. This is likely reflective of longer follow-up and discovery time, as the SAH group had a statistically significantly longer time between the initial treatment and the discovery of the de novo aneurysm (p=0.011).
     This is a retrospective study.
     While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than similarly sized, initially discovered unruptured aneurysms. Our data suggests that this risk is cumulative.
     We therefore recommend long-term follow-up of all aneurysm patients and possibly a more aggressive treatment strategy for those with de novo aneurysms.


Project Roles:

D. Fulkerson (), W. Kemp III (), T. Payner (), T. Leipzig (), A. Cohen-Gadol (), T. Horner ()