Enhancing decision-making strategies in treatment for unruptured intracranial aneurysms: a novel analytical approach using PHASES, ELAPSS and UIATS scores for microsurgical clipping outcome prediction.

Objective: The management of unruptured intracranial aneurysms (UIA) is complex, balancing the risks of surgical intervention against aneurysm rupture. The PHASES, ELAPSS, and UIATS scoring systems have been developed to assist in clinical decision-making, but their efficacy in predicting surgical outcome remains unclear.

Methods: In this monocentric, retrospective, observational study, we included 380 patients with UIA from January 2010 to January 2021. We assessed the predictive value of the PHASES, ELAPSS, and UIATS scores in determining clinical outcome post-surgery, including different variables. Statistical analyses, including Principal Component Analysis and Multiple logistic and linear regression, were employed to analyze the data.

Results: Our cohort of 380 predominantly female patients (71.3%) had a mean age of 54.7 years. The PHASES and UIATS pro-conservative scores were significant predictors of poor clinical outcome (p = 0.03 and p = 0.04, respectively), while the ELAPSS score was predictive of new neurological deficits post-surgery (p = 0.01). Aneurysm size was significantly associated with new neurological deficits but not with long-term clinical performance/outcome.

Conclusions: The study underscores the utility of PHASES, ELAPSS, and UIATS scores in preoperative risk stratifications. Conservative PHASES and UIATS scores were associated with poor outcome, therefore supporting their predictive value of non-operative management. Our findings suggest the routine implementation of these scores into clinical practice could improve the management of UIAs.