Management of unruptured intracranial aneurysm Z.Jamaleddine, S.El Haddad, A.El Quessar Service de Radiologie, Hopital Cheikh Zaid Rabat - Maroc

INTRODUCTION The prevalence of the intracranial aneurysm is estimated between 1and 5 %. Management of unruptured aneurysm patients is a current topic of debate.

OBJECTIVE Evaluating : Efficacy , Utility , Dangers of endovascular treatment.

MATERIALS AND METHODS Retrospective study November 2006 to march 2012. Patients: 23 UIA: 28

MATERIALS AND METHODS Will be excluded from this study: 4 patients with compressive UIA 3 carotido- ophtalmic 1 intra-cavernous All these aneurysms were confirmed by cerebral angiography.

RESULTS The average age is 51 years (38-71 years)

RESULTS Sex: 10 woman 9man

RESULTS Antecedents: Smoke: 7 cases Hypertension: 5 cases Family cases: 1 case

Discovery circumstances SAH AVM Fortuitous discovery Aneurysms (24) 20 2 Percentage (%) 83,33% 8,33%

RESULTS Neurological state at discovery of aneurysm: Glascow Coma Scale (GCS) in 15 at 16 patients. GCS in 14 at 2 patients. GCS in 9 at another patient hospitalized for a recent brain haemorrhage of another associated aneurysm.

79% Aneurysm localization (24 aneurysms) 21% Seat Number Percentage Carotido-ophtalmic 6 25% MCA 5 20,8% Anterior Communicating 4 16,6% Ending of the internal carotid Basilar trunc 2 8,4% Posterior communicating Posterior cerebral 1 4,2% 79% 21%

RESULTS 17 aneurysms were embolised : 12 aneurysms were embolised simultaneously with another responsible of SAH, and 1 at distance of the hemorrhagic accident. 2 large aneurysms discovred at CT. 2 aneurysms for AVM assessment.

RESULTS 3 aneurysms were respected (small size < 3mm). 4 aneurysms were respected in the same patient. Regular monitoring is imposed for untreated aneurysms by MR angiography or/and arteriography (in 6 months of its discovery, then every year).

EVOLUTION Clinical follow-up: 17 patients Lost sight after 6 months: 1 patient Normal life: 14 patients Death: 2 patients (1 after complication of SAH, other after thrombosis complication)

EVOLUTION Angio-IRM of control: 10 patients Arteriography of control: 7 patients Not yet checked (< 6 months): 4 patients Second Recurrence: 0/17 checked aneurysms

DISCUSSION The prevalence is between 1 and 5% of the adult population. Autopsy studies have shown that the overall frequency in the general population ranges from 0.8% to 10%. The risk may increase especially in patients with a familial aneurysm or polycystic kidney disease.

DISCUSSION The incidental discovery of UIA is more and more frequent with the increasing availability of non invasive imaging techniques. The therapeutic decision is influenced by the other factors sometimes difficult to quantify in particular psychic.

DISCUSSION The preventive treatment is envisaged only if the risks bound to the treatment are low in comparison with those of the natural story of the aneurysm. The choice of the treatment defined by ISUIA at the 7 mm threshold is not the only criteria, clinical factors, morphology and chronological modifications are also taken into account for the therapeutic strategy (ATENA).

DISCUSSION In ATENA –ISUIA the rate of faillure and rupture is significantly linked to location and aneurysm size. The risk of rupture is lower of small aneurysm but the rate of faillure is increased The risk of faillure and rupture is lower in anterior location.

DISCUSSION The rate of faillure is different according to the aneurysm size Result from ATENA Size Faillure < 7mm 5, 7% 7- 15 2, 3%

DISCUSSION The risk of morbidity and mortality of embolization is low compared to surgical treatment. As Pierot, increasing the number of people treated by embolization reduces that risk, but this is not significant

DISCUSSION ATENA Treatment Endovascular (%) Neurosurgical Morbidity 1,2 – 3,8 10,9 Mortality 1,2 – 2,3 2,6

Conclusion Unruptured aneurysms responsible for a tumor syndrome should be treated. The fortuite discovery of intracranial aneurysm should be supported: Embolization to avoid any risk of bleeding. Embolization is according on the clinical characteristics and morphological aneurysm Non-embolized aneurysms should be monitored regularly.