Clinical characteristics and management for intracranial serpentine aneurysms: a 12-year single-center retrospective analysis of 51 patients.

Background: Serpentine aneurysms, a rare and complex type of intracranial aneurysm, pose significant treatment challenges. The natural course of these aneurysms and the definitive interventional treatment effect remains elusive. This study aims to delineate the characteristics of serpentine aneurysms, explore the risk factors influencing their progression, and compare the postoperative outcomes among different treatment.

Results: This study enrolled 51 patients with an average age of 44.31 years (range 11-75), of whom 29 (59%) were men. Comorbidities included heart disease in 2 patients (3.9%), high cholesterol in 7 (14%), and neoplasm in 1 (2%). Various symptoms were reported: dizziness in 9 patients (17.6%), with headache being the most common symptom, observed in 18 (35.3%). Among the cohort, 58.8% (30/51) opted for conservative observation, while 41.2% (21/51) underwent interventional treatment, including 7 cases of endovascular therapy and 14 cases of microsurgical revascularization. Most aneurysms exhibited a slow progression pattern, with a median symptom duration of 1 month. Interventional treatment, regardless of the approach, significantly reduced the risk of aneurysm progression over 8 years (p = 0.02). In the observation cohort, both univariate and multivariate analyses identified aneurysm length as a potential independent risk factor for aneurysm progression (aOR = 1.169, 95% CI: 1.043-1.383, p = 0.024). Postoperative analysis revealed that surgical treatment reduced modified Rankin Scale (mRS) scores within the first year. Patients undergoing endovascular therapy appeared to have better mRS outcomes compared to those treated with microsurgery. Male gender was also identified as an independent predictor of aneurysm progression.

Conclusions: Intracranial serpentine aneurysms are slowly progressing lesions, and aneurysm length exceeding 20.5 mm is a critical risk factor for progression. Interventional treatment significantly reduces the risk of aneurysm progression over the long term. Tailored treatment strategies are necessary, with surgical or interventional approaches carefully considered for patients with high-risk factors.