Influence of age and comorbidity on the frequency of complications of surgical treatment of unruptured intracranial aneurysms.

Abstract

Neurosurgeons are increasingly challenged with balancing the risks of unruptured aneurysm growth and rupture against the potential complications of surgical treatment. Equally important is an objective assessment of surgical complications in relation to the patient's age and comorbidities, which was the primary focus of this study. This single-center, retrospective, observational study included patients from the Burdenko Neurosurgical Center who underwent microsurgical or endovascular treatment for unruptured intracranial aneurysms (UIAs). Patient age and comorbidity were evaluated using the ASA Physical Status Classification System and the Charlson Comorbidity Index. Intrahospital complications and the occurrence of new neurological deficits were recorded. The study included 1,904 patients, with 1,051 in the microsurgical group and 853 in the endovascular group. The overall incidence of new neurological deficits was 7.4%, with rates of 9.7% in the microsurgical group and 4.5% in the endovascular group (p < 0.001, Pearson's chi-squared test = 19.052). Moderate to severe intrahospital complications occurred in 5.8% of cases overall, with 8.1% in the microsurgical group and 2.9% in the endovascular group (p < 0.001 (Pearson's chi-squared test = 47.778). A comprehensive analysis of the retrospective cohort was performed to assess whether the incidence of these complications varied according to patient age and comorbidity. All statistically significant results were incorporated into age-comorbidity scales. To facilitate their use, a web application was developed: http://acsforaneurysm.ru/en/ . The findings of this study provide valuable data for comparing the risks of the natural cousre of unruptured aneurysms with surgical risks. This information is particularly useful in determining whether to opt for observation or surgical intervention, as well as in selecting the optimal timing for surgery.