{
  "abstract": "Background Evidence regarding the clinical course of unruptured giant intracranial aneurysms (GIAs) after conservative management (CON), microsurgical treatment (SURG) or endovascular treatment (EVT) remains limited. We aimed to assess mortality, functional outcome, symptom course and retreatment rates after different management strategies.Methods In this prospective, multinational registry, patients with unruptured GIAs treated at 37 neurovascular centres between 2008 and 2018 were included. Outcomes after CON, EVT or SURG were analysed with standardised 3-year follow-up. The study is registered at ClinicalTrials.gov.Results We included 339 patients of whom 22.7% received CON, 42.8% EVT and 34.5% SURG. Three-year survival was 64.0% (95% CI 53.73% to 76.20%) in the CON group, 82.0% (95% CI 75.42% to 89.17%) in the EVT group and 93.5% (95% CI 88.91% to 98.28%) in the SURG group (p<0.001). Favourable neurological outcome (modified Rankin Scale 0–2) declined to 53.0%, 66.9% and 75.7% in the CON, EVT and SURG groups, respectively (p<0.01). Symptom improvement at 3 years occurred in 10.3% of CON, 22.1% of EVT and 11.1% of SURG patients, while deterioration was observed in 7.7%, 8.5% and 15.8%, respectively. Retreatment was required in 22.8% of EVT patients and 6.2% of SURG patients (p<0.01).Conclusions EVT and SURG were associated with significantly improved survival and functional outcomes compared with conservative management of unruptured GIAs. In patients eligible for intervention, both treatment modalities represent reasonable and effective options, with a high proportion of patients achieving favourable clinical outcomes.Trial registration number NCT02066493.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany",
        "Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany"
      ],
      "name": "Lars Wessels"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany",
        "Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany"
      ],
      "name": "Kiarash Ferdowssian"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany"
      ],
      "name": "Julius Dengler"
    },
    {
      "affiliations": [
        "Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany"
      ],
      "name": "Lukas Mödl"
    },
    {
      "affiliations": [
        "Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany"
      ],
      "name": "Erin D Sprünken"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Ospedale Niguarda Ca’ Granda, Milano, Italy"
      ],
      "name": "Marco Cenzato"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Milano, Italy"
      ],
      "name": "Edoardo Boccardi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland"
      ],
      "name": "Luca Regli"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France"
      ],
      "name": "Christophe Cognard"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Ruben Dammers"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland"
      ],
      "name": "Mika Niemelä"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany"
      ],
      "name": "Lasse Dührsen"
    },
    {
      "affiliations": [
        "Department Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany"
      ],
      "name": "Joachim K Krauss"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland"
      ],
      "name": "Karl Schaller"
    },
    {
      "affiliations": [
        "Neurosurgery Division, Geneva University Hospitals, Geneva, Switzerland"
      ],
      "name": "Philippe Bijlenga"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Vienna General Hospital, Vienna, Austria"
      ],
      "name": "Wei-Te Wang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Spine Surgery and Interventional Neuroradiology, DONAUISAR Klinikum Deggendorf-Dingolfing-Landau, Deggendorf, Germany"
      ],
      "name": "Stefan A Rath"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Hospital Rechts der Isar, Munich, Germany"
      ],
      "name": "Italo Linfante"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany"
      ],
      "name": "Karl-Michael Schebesch"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany",
        "Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany"
      ],
      "name": "Nils O Schmidt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Ulm University Hospital, Ulm, Germany"
      ],
      "name": "Ralph W König"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan"
      ],
      "name": "Naoki Kato"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany"
      ],
      "name": "Jürgen Beck"
    },
    {
      "affiliations": [
        "Department Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany"
      ],
      "name": "Ulrich Sure"
    },
    {
      "affiliations": [
        "Department Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany"
      ],
      "name": "Karsten H Wrede"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland"
      ],
      "name": "Serge Marbacher"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany",
        "Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany"
      ],
      "name": "Johannes Lemcke"
    },
    {
      "affiliations": [
        "Centre for Neuroradiology, Clinic Hirslanden, Zurich, Switzerland",
        "Department of Neurosurgery, Berufsgenossenschaftliche Kliniken Bergmannstrost Halle, Halle, Germany"
      ],
      "name": "Hans J Meisel"
    },
    {
      "affiliations": [
        "Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany",
        "Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany"
      ],
      "name": "Matthias Endres"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Hospital Rechts der Isar, Munich, Germany"
      ],
      "name": "Bernhard Meyer"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany"
      ],
      "name": "Veit Rohde"
    },
    {
      "affiliations": [
        "Centre for Neuroradiology, Clinic Hirslanden, Zurich, Switzerland"
      ],
      "name": "Daniel A Rüfenacht"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany",
        "Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany"
      ],
      "name": "Peter Vajkoczy"
    },
    {
      "affiliations": [],
      "name": "Giant Intracranial Aneurysm Registry Study Group"
    }
  ],
  "title": "Clinical outcomes of conservative, endovascular and microsurgical management of unruptured giant intracranial aneurysms: 3-year follow-up of the prospective, multinational Giant Intracranial Aneurysm Registry",
  "uid": "0ee84277-3850-5461-880f-57c9fe030d6c"
}