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Journal of Neurosurgical Sciences 2018 May 28

DOI: 10.23736/S0390-5616.18.04498-3


lingua: Inglese

Application of PHASES and ELAPSS scores to ruptured cerebral aneurysms: how many would have been conservatively managed?

Christopher A. HILDITCH 1 , Waleed BRINJIKJI 1, Anderson C. TSANG 1, Patrick NICHOLSON 1, Alex KOSTYNSKYY 1, Michael TYMIANSKI 2, Timo KRINGS 1, 3, Ivan RADOVANOVIC 2, Vitor M. PEREIRA 1, 3

1 Division of Neuroradiology, Joint Division of Medical Imaging, University Health Network, University of Toronto, Toronto ON, Canada; 2 Division of Neurosurgery, University Health Network, University of Toronto, Toronto ON, Canada; 3 Division of Neurosurgery, Department of Surgery, University Health Network, University of Toronto, Toronto ON, Canada


BACKGROUND AND PURPOSE: We calculated the PHASES and ELAPSS scores for a large cohort of ruptured intracranial aneurysms (RIA) in order to determine whether these RIA would have been pre-emptively treated or closely followed-up should they have been detected prior to rupture.
MATERIALS AND METHODS: We retrospectively reviewed a consecutive series of RIA over a 20 year period. The primary outcome of this study was the PHASES score of each ruptured aneurysm included. Secondary outcomes were ELAPSS score and other risk factors for aneurysmal subarachnoid haemorrhage including; aneurysm location, aneurysm size, aneurysm morphology, smoking and hypertension history, personal and family history of subarachnoid haemorrhage. Multiplicity of cerebral aneurysms was recorded. Descriptive statistics are reported.
RESULTS: 700 consecutive ruptured aneurysms were included. Mean age at rupture was 56 (+/-13.5) years. Mean aneurysm size was 5.9 (+/-2.5) mm. Most common locations of ruptured aneurysms was the anterior cerebral/communicating artery (39%), posterior communicating artery (21%), middle cerebral artery (16%) and basilar terminus (7%). Mean PHASES score was 5.3 (+/-2.5) and 17% of the RIA had a PHASES score of 3 or less. Mean ELAPSS score was 13.89 (+/-7.05) and over half of the RIA included had a low risk of future growth.
CONCLUSIONS: A reasonable percentage of ruptured aneurysms have a low calculated PHASES score and these aneurysms may have been managed conservatively should they have presented incidentally prior to rupture. The majority of ruptured aneurysms also had a low ELAPSS score and were at low risk of future growth. The use PHASES score and ELAPSS score alone when making treatment decisions could result in many aneurysms being treated conservatively or undergoing remote surveillance despite rupture potential.

KEY WORDS: Subarachnoid haemorrhage - Ruptured aneurysms - PHASES score - ELAPSS score

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