Qingping Joseph Feng , Kah Jun Tham , Chin Lik Tan
{"title":"全麻在未破裂颅内动脉瘤患者行非动脉瘤相关手术中的安全性:一项系统综述。","authors":"Qingping Joseph Feng , Kah Jun Tham , Chin Lik Tan","doi":"10.1016/j.jocn.2025.111646","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The increasing utilization of neuroimaging has led to a rising number of incidental unruptured intracranial aneurysms (UIAs). Most UIAs carry a low rupture risk, but concerns remain regarding the potential impact of general anesthesia (GA) on perioperative aneurysm stability. This systematic review aims to evaluate the incidence of perioperative aneurysmal rupture in patients with UIAs undergoing GA for non-aneurysm-related procedures.</div></div><div><h3>Methods</h3><div>A search of the PubMed and EMBASE databases identified studies reporting adult patients with UIAs undergoing GA for non-aneurysm-related surgeries, detailing aneurysm characteristics and rupture incidence. The primary outcome was aneurysmal rupture during or within 48 h of surgery, and the secondary outcome was aneurysm-rupture-related mortality. Perioperative management strategies were also reviewed.</div></div><div><h3>Results</h3><div>A total of 21 studies involving 627 patients were included. The majority were case reports or small series, alongside three larger cohort studies. Across all patients, only one case of perioperative aneurysmal rupture (0.16 %) was identified, with no rupture-related mortality. Most aneurysms were small (<7 mm) and located in the anterior circulation. No specific surgical procedure or anesthetic technique was associated with an increased rupture risk. Several studies highlighted the importance of meticulous intraoperative hemodynamic management, although no standardized protocols were reported.</div></div><div><h3>Conclusion</h3><div>This systematic review demonstrates that GA is generally safe for patients with UIAs undergoing non-aneurysm-related surgery, with an extremely low risk of perioperative rupture and no associated mortality. Current evidence does not support prophylactic aneurysm treatment. Individualized risk assessment and vigilant perioperative blood pressure management are key to maintaining safety in this population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111646"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety of general anesthesia in patients with unruptured intracranial aneurysms undergoing non-aneurysm-related surgery: A systematic review\",\"authors\":\"Qingping Joseph Feng , Kah Jun Tham , Chin Lik Tan\",\"doi\":\"10.1016/j.jocn.2025.111646\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>The increasing utilization of neuroimaging has led to a rising number of incidental unruptured intracranial aneurysms (UIAs). Most UIAs carry a low rupture risk, but concerns remain regarding the potential impact of general anesthesia (GA) on perioperative aneurysm stability. This systematic review aims to evaluate the incidence of perioperative aneurysmal rupture in patients with UIAs undergoing GA for non-aneurysm-related procedures.</div></div><div><h3>Methods</h3><div>A search of the PubMed and EMBASE databases identified studies reporting adult patients with UIAs undergoing GA for non-aneurysm-related surgeries, detailing aneurysm characteristics and rupture incidence. The primary outcome was aneurysmal rupture during or within 48 h of surgery, and the secondary outcome was aneurysm-rupture-related mortality. Perioperative management strategies were also reviewed.</div></div><div><h3>Results</h3><div>A total of 21 studies involving 627 patients were included. The majority were case reports or small series, alongside three larger cohort studies. Across all patients, only one case of perioperative aneurysmal rupture (0.16 %) was identified, with no rupture-related mortality. Most aneurysms were small (<7 mm) and located in the anterior circulation. No specific surgical procedure or anesthetic technique was associated with an increased rupture risk. Several studies highlighted the importance of meticulous intraoperative hemodynamic management, although no standardized protocols were reported.</div></div><div><h3>Conclusion</h3><div>This systematic review demonstrates that GA is generally safe for patients with UIAs undergoing non-aneurysm-related surgery, with an extremely low risk of perioperative rupture and no associated mortality. Current evidence does not support prophylactic aneurysm treatment. Individualized risk assessment and vigilant perioperative blood pressure management are key to maintaining safety in this population.</div></div>\",\"PeriodicalId\":15487,\"journal\":{\"name\":\"Journal of Clinical Neuroscience\",\"volume\":\"142 \",\"pages\":\"Article 111646\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Neuroscience\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0967586825006198\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967586825006198","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Safety of general anesthesia in patients with unruptured intracranial aneurysms undergoing non-aneurysm-related surgery: A systematic review
Objective
The increasing utilization of neuroimaging has led to a rising number of incidental unruptured intracranial aneurysms (UIAs). Most UIAs carry a low rupture risk, but concerns remain regarding the potential impact of general anesthesia (GA) on perioperative aneurysm stability. This systematic review aims to evaluate the incidence of perioperative aneurysmal rupture in patients with UIAs undergoing GA for non-aneurysm-related procedures.
Methods
A search of the PubMed and EMBASE databases identified studies reporting adult patients with UIAs undergoing GA for non-aneurysm-related surgeries, detailing aneurysm characteristics and rupture incidence. The primary outcome was aneurysmal rupture during or within 48 h of surgery, and the secondary outcome was aneurysm-rupture-related mortality. Perioperative management strategies were also reviewed.
Results
A total of 21 studies involving 627 patients were included. The majority were case reports or small series, alongside three larger cohort studies. Across all patients, only one case of perioperative aneurysmal rupture (0.16 %) was identified, with no rupture-related mortality. Most aneurysms were small (<7 mm) and located in the anterior circulation. No specific surgical procedure or anesthetic technique was associated with an increased rupture risk. Several studies highlighted the importance of meticulous intraoperative hemodynamic management, although no standardized protocols were reported.
Conclusion
This systematic review demonstrates that GA is generally safe for patients with UIAs undergoing non-aneurysm-related surgery, with an extremely low risk of perioperative rupture and no associated mortality. Current evidence does not support prophylactic aneurysm treatment. Individualized risk assessment and vigilant perioperative blood pressure management are key to maintaining safety in this population.
期刊介绍:
This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology.
The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.