Complex intracranial aneurysms: a DELPHI study to define associated characteristics

Francesco Diana^{1

2

3}, Michele Romoli⁴, Eytan Raz⁵, Ronit Agid⁶, Felipe C Albuquerque⁷, Adam S Arthur⁸, Jürgen Beck⁹, Jerome Berge¹⁰, Hieronymus D Boogaarts¹¹, Jan-Karl Burkhardt¹², Marco Cenzato¹³, René Chapot¹⁴, Fady T Charbel¹⁵, Hubert Desal¹⁶, Giuseppe Esposito¹⁷, Johanna T Fifi¹⁸, Stefan Florian¹⁹, Andreas Gruber²⁰, Ameer E Hassan²¹, Pascal Jabbour²², Ashutosh P Jadhav⁷, Miikka Korja²³, Timo Krings²⁴, Giuseppe Lanzino²⁵, Torstein R Meling²⁶, Jaques Morcos²⁷, Pascal J Mosimann²⁴, Erez Nossek²⁸, Vitor Mendes Pereira²⁹, Andreas Raabe³⁰, Luca Regli¹⁷, Veit Rohde³¹, Adnan H Siddiqui³², Rokuya Tanikawa³³, Stavropoula I Tjoumakaris³⁴, Alejandro Tomasello^{1

2}, Peter Vajkoczy³⁵, Luca Valvassori³⁶, Nikolay Velinov³⁷, Daniel Walsh³⁸, Henry Woo³⁹, Bin Xu⁴⁰, Shinichi Yoshimura⁴¹, Wim H van Zwam⁴², Simone Peschillo⁴³

Affiliations

¹ Interventional Neuroradiology, University Hospital Vall d'Hebron, Barcelona, Spain.
² Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
³ Department of Scienze della Vita, Della Salute e delle Professioni Sanitarie Link Campus University, Rome, Italy.
⁴ Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy.
⁵ Department of Radiology, New York University Langone Health, New York, NY, USA.
⁶ Division of Neuroradiology, JDMI, University Health Network, Toronto, Canada.
⁷ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
⁸ University of Tennessee, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA.
⁹ Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁰ Interventional Neuroradiology Department, CHRU, Bordeaux, France.
¹¹ Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands.
¹² Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, USA.
¹³ Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁴ Department of Interventional Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany.
¹⁵ Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
¹⁶ Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France.
¹⁷ Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
¹⁸ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁹ Department of Neurosurgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj County Clinical Emergency Hospital, Cluj-Napoca, Romania.
²⁰ Department of Neurosurgery, Johannes Kepler University, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.
²¹ Department of Neurology, Valley Baptist - University of Texas Rio Grande Valley, Harlingen, TX, USA.
²² Department of Neurosurgery, Thomas Jefferson Hospital, Philadelphia, PA, USA.
²³ Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
²⁴ Interventional and Diagnostic Neuroradiology, University of Toronto & Toronto Western Hospital, Toronto, ON, Canada.
²⁵ Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
²⁶ Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.
²⁷ Vivian L. Smith Department of Neurosurgery, UTHealth Houston Neurosciences, Houston, TX, USA.
²⁸ Department of Neurosurgery, New York University School of Medicine, New York, NY, USA.
²⁹ Division of Neurosurgery, Departments of Surgery & Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³⁰ Department of Neurosurgery Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
³¹ Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany.
³² Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
³³ Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
³⁴ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
³⁵ Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³⁶ Neuroradiology Unit, Ospedale San Carlo, Milan, Italy.
³⁷ Clinics of Neurosurgery, Vascular and Endovascular Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria.
³⁸ King's College Hospital NHS Foundation Trust, London, UK.
³⁹ Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
⁴⁰ Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
⁴¹ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
⁴² Department of Radiology and Nuclear Medicine, School for Cardiovascular Diseases (CARIM), Maastricht UMC+, Maastricht, The Netherlands.
⁴³ Endovascular Neurosurgery, Guido Guglielmi Endowed Chair in Endovascular Neurosurgery, Unicamillus International University of Health Sciences, Rome, Italy. simone.peschillo@gmail.com.

PMID: 38990336
DOI: 10.1007/s00701-024-06182-z

Complex intracranial aneurysms: a DELPHI study to define associated characteristics

Francesco Diana et al. Acta Neurochir (Wien). 2024.

. 2024 Jul 11;166(1):294.

doi: 10.1007/s00701-024-06182-z.

Authors

Affiliations

¹ Interventional Neuroradiology, University Hospital Vall d'Hebron, Barcelona, Spain.
² Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
³ Department of Scienze della Vita, Della Salute e delle Professioni Sanitarie Link Campus University, Rome, Italy.
⁴ Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy.
⁵ Department of Radiology, New York University Langone Health, New York, NY, USA.
⁶ Division of Neuroradiology, JDMI, University Health Network, Toronto, Canada.
⁷ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
⁸ University of Tennessee, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA.
⁹ Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.
¹⁰ Interventional Neuroradiology Department, CHRU, Bordeaux, France.
¹¹ Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands.
¹² Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, USA.
¹³ Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
¹⁴ Department of Interventional Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany.
¹⁵ Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
¹⁶ Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France.
¹⁷ Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
¹⁸ Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁹ Department of Neurosurgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj County Clinical Emergency Hospital, Cluj-Napoca, Romania.
²⁰ Department of Neurosurgery, Johannes Kepler University, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.
²¹ Department of Neurology, Valley Baptist - University of Texas Rio Grande Valley, Harlingen, TX, USA.
²² Department of Neurosurgery, Thomas Jefferson Hospital, Philadelphia, PA, USA.
²³ Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
²⁴ Interventional and Diagnostic Neuroradiology, University of Toronto & Toronto Western Hospital, Toronto, ON, Canada.
²⁵ Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
²⁶ Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.
²⁷ Vivian L. Smith Department of Neurosurgery, UTHealth Houston Neurosciences, Houston, TX, USA.
²⁸ Department of Neurosurgery, New York University School of Medicine, New York, NY, USA.
²⁹ Division of Neurosurgery, Departments of Surgery & Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³⁰ Department of Neurosurgery Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
³¹ Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany.
³² Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
³³ Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
³⁴ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
³⁵ Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³⁶ Neuroradiology Unit, Ospedale San Carlo, Milan, Italy.
³⁷ Clinics of Neurosurgery, Vascular and Endovascular Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria.
³⁸ King's College Hospital NHS Foundation Trust, London, UK.
³⁹ Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
⁴⁰ Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
⁴¹ Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
⁴² Department of Radiology and Nuclear Medicine, School for Cardiovascular Diseases (CARIM), Maastricht UMC+, Maastricht, The Netherlands.
⁴³ Endovascular Neurosurgery, Guido Guglielmi Endowed Chair in Endovascular Neurosurgery, Unicamillus International University of Health Sciences, Rome, Italy. simone.peschillo@gmail.com.

PMID: 38990336
DOI: 10.1007/s00701-024-06182-z

Abstract

Purpose: Intracranial aneurysms present significant health risks, as their rupture leads to subarachnoid haemorrhage, which in turn has high morbidity and mortality rates. There are several elements affecting the complexity of an intracranial aneurysm. However, criteria for defining a complex intracranial aneurysm (CIA) in open surgery and endovascular treatment could differ, and actually there is no consensus on the definition of a "complex" aneurysm. This DELPHI study aims to assess consensus on variables defining a CIA.

Methods: An international panel of 50 members, representing various specialties, was recruited to define CIAs through a three-round Delphi process. The panelists participated in surveys with Likert scale responses and open-ended questions. Consensus criteria were established to determine CIA variables, and statistical analysis evaluated consensus and stability.

Results: In open surgery, CIAs were defined by fusiform or blister-like shape, dissecting aetiology, giant size (≥ 25 mm), broad neck encasing parent arteries, extensive neck surface, wall calcification, intraluminal thrombus, collateral branch from the sac, location (AICA, SCA, basilar), vasospasm context, and planned bypass (EC-IC or IC-IC). For endovascular treatment, CIAs included giant size, very wide neck (dome/neck ratio ≤ 1:1), and collateral branch from the sac.

Conclusions: The definition of aneurysm complexity varies by treatment modality. Since elements related to complexity differ between open surgery and endovascular treatment, these consensus criteria of CIAs could even guide in selecting the best treatment approach.

Keywords: Brain aneurysm; Clipping; Coiling; DELPHI; SAH.

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References

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Complex intracranial aneurysms: a DELPHI study to define associated characteristics

Affiliations

Complex intracranial aneurysms: a DELPHI study to define associated characteristics

Authors

Affiliations

Abstract

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical