The Role and Reliability of Unruptured Intracranial Aneurysm Treatment Score in Decision-making in Surgical Indications for Unruptured Intracranial Aneurysms Based on the Results at a Japanese Single Center

Abstract

To clarify the role and reliability of unruptured intracranial aneurysm treatment score in the treatment indications of unruptured intracranial aneurysm for Japanese patients, we performed a retrospective comparative analysis of our actual decision-making and unruptured intracranial aneurysm treatment score judgment. The unruptured intracranial aneurysm treatment score was applied to each of 208 Japanese patients with diagnosis of unruptured intracranial aneurysm for a year. The patients included were classified into 4 groups by integrating actual decisions with the scoring of unruptured intracranial aneurysm treatment score. Of 94 patients treated, unruptured intracranial aneurysm treatment score recommended repair for 64 (68.1%, "appropriately treated") and observation for 5 (5.3%, "possible over-treated"). Among 114 patients under observation, unruptured intracranial aneurysm treatment score recommended repair for 19 (16.7%, "possible under-treated") and observation for 29 (25.4%, "appropriately conservative"). In the remaining 91 patients judged as "not definitive" by the unruptured intracranial aneurysm treatment score, 66 (72.5%) were determined as conservative follow-up. From the perspective of the unruptured intracranial aneurysm treatment score, its sensitivity and specificity were 85.3% and 88.6%, respectively. Our findings suggest that in Japanese patients with unruptured intracranial aneurysm, unruptured intracranial aneurysm treatment score is a reliable tool for guiding treatment decisions for unexpertized clinicians; however, the final judgment should be made by a trained neurosurgeon, especially in cases categorized as not definitive.