Philippe Bijlenga1, Renato Gondar2, Sabine Schilling2, Sandrine Morel2, Sven Hirsch2, Johanna Cuony2, Marco-Vincenzo Corniola2, Fabienne Perren2, Daniel Rüfenacht2, Karl Schaller2. 1. From the Division of Neurosurgery (P.B., R.G., S.M., J.C., M.-V.C., K.S.) and Division of Neurology (F.P.), Clinical Neurosciences Department, Faculty of Medicine, University of Geneva, Switzerland; Institute for Applied Simulations, University of Applied Sciences, Wädenswil, Switzerland (S.S., S.H.); and Neuroradiologie, SwissNeuroInstitute, Klinik Hirslanden, Zürich, Switzerland (D.R.). philippe.bijlenga@hcuge.ch. 2. From the Division of Neurosurgery (P.B., R.G., S.M., J.C., M.-V.C., K.S.) and Division of Neurology (F.P.), Clinical Neurosciences Department, Faculty of Medicine, University of Geneva, Switzerland; Institute for Applied Simulations, University of Applied Sciences, Wädenswil, Switzerland (S.S., S.H.); and Neuroradiologie, SwissNeuroInstitute, Klinik Hirslanden, Zürich, Switzerland (D.R.).
Abstract
BACKGROUND AND PURPOSE: The aim of this study is to assess whether the PHASES score allows to (1) match decisions taken by multidisciplinary team whether to observe or intervene, (2) classify patients being diagnosed with a ruptured versus unruptured intracranial aneurysm (UIA), and (3) discriminate patients at low risk of rupture from the population of patients diagnosed with intracranial aneurysm. METHODS: Population-based prospective and consecutive data were collected between 2006 and 2014. Patients (n=841) were stratified into 4 groups: stable UIA; growing observed UIA; immediately treated UIA; and aneurysmal subarachnoid hemorrhage (aSAH). All patients initially observed were pooled in a follow-up UIA group; patients from growing observed UIA, immediately treated UIA, and aSAH were pooled in a high risk of rupture group. Results are expressed as median [quartile 1, quartile 3]. RESULTS: PHASES scores of immediately treated UIA patients were significantly higher than follow-up UIA group (5 [3, 7] versus 2 [1, 4]). Patients diagnosed with UIA and PHASES score of >3 were more likely to be treated, and the score ≤3 was predictive for observation (areas under these curves=0.74). Odds of being diagnosed with an aSAH were associated with PHASES score of >3 (UIA, 4 [2, 6]; aSAH, 5 [4, 8]; areas under these curves=0.66). Scores of stable UIA patients were significantly lower than high risk of rupture group (2 [1, 4] versus 5 [4, 7]; stable UIA outcome prediction by PHASES score of ≤3: areas under these curves=0.76). CONCLUSIONS: There is a progression of PHASES score between stable UIA, growing observed UIA, immediately treated UIA, and aSAH groups. PHASES score of ≤3 is associated with a low but not negligible likelihood of aneurysm rupture, and specificity of the classifier is low.
BACKGROUND AND PURPOSE: The aim of this study is to assess whether the PHASES score allows to (1) match decisions taken by multidisciplinary team whether to observe or intervene, (2) classify patients being diagnosed with a ruptured versus unruptured intracranial aneurysm (UIA), and (3) discriminate patients at low risk of rupture from the population of patients diagnosed with intracranial aneurysm. METHODS: Population-based prospective and consecutive data were collected between 2006 and 2014. Patients (n=841) were stratified into 4 groups: stable UIA; growing observed UIA; immediately treated UIA; and aneurysmal subarachnoid hemorrhage (aSAH). All patients initially observed were pooled in a follow-up UIA group; patients from growing observed UIA, immediately treated UIA, and aSAH were pooled in a high risk of rupture group. Results are expressed as median [quartile 1, quartile 3]. RESULTS: PHASES scores of immediately treated UIApatients were significantly higher than follow-up UIA group (5 [3, 7] versus 2 [1, 4]). Patients diagnosed with UIA and PHASES score of >3 were more likely to be treated, and the score ≤3 was predictive for observation (areas under these curves=0.74). Odds of being diagnosed with an aSAH were associated with PHASES score of >3 (UIA, 4 [2, 6]; aSAH, 5 [4, 8]; areas under these curves=0.66). Scores of stable UIApatients were significantly lower than high risk of rupture group (2 [1, 4] versus 5 [4, 7]; stable UIA outcome prediction by PHASES score of ≤3: areas under these curves=0.76). CONCLUSIONS: There is a progression of PHASES score between stable UIA, growing observed UIA, immediately treated UIA, and aSAH groups. PHASES score of ≤3 is associated with a low but not negligible likelihood of aneurysm rupture, and specificity of the classifier is low.
Authors: Felicitas J Detmer; Bong Jae Chung; Fernando Mut; Martin Slawski; Farid Hamzei-Sichani; Christopher Putman; Carlos Jiménez; Juan R Cebral Journal: Int J Comput Assist Radiol Surg Date: 2018-08-09 Impact factor: 2.924
Authors: Jason Brett Hartman; Hiroko Watase; Jie Sun; Daniel S Hippe; Louis Kim; Michael Levitt; Laligam Sekhar; Niranjan Balu; Thomas Hatsukami; Chun Yuan; Mahmud Mossa-Basha Journal: Br J Radiol Date: 2019-01-30 Impact factor: 3.039
Authors: Felicitas J Detmer; Daniel Fajardo-Jiménez; Fernando Mut; Norman Juchler; Sven Hirsch; Vitor Mendes Pereira; Philippe Bijlenga; Juan R Cebral Journal: Acta Neurochir (Wien) Date: 2018-10-30 Impact factor: 2.216