group I), the surgery-related morbidity and mortality combined was about 17.5 percent at 30 days and about 15.9 percent at 1 year. For patients with a history of subarachnoid hemorrhage (group II), the combined surgery-related morbidity and mortality was less, about 13.6 percent at 30 days and about 13.2 percent at 1 year. One reason for this may be the average age difference between the two groups. Younger patients had substantially less operative morbidity and mortality than older patients and group II patients were younger than group I patients (an average of 47 versus 53 years old).

The investigators concluded that the likelihood of rupture of aneurysms less than 10 mm in diameter is exceedingly low among group I patients and that the combined morbidity and mortality rate related to surgery greatly exceeds the 7 1/2 year risk of rupture in these patients. They therefore advise against surgery for most patients who have aneurysms less than 10 mm in diameter and are without a history of subarachnoid hemorrhage. Other risk factors that surgeons should take into account before performing aneurysm surgery are the patient's history of previous subarachnoid hemorrhage, and the size and location of the aneurysm.

Dr. Wiebers states that the study should not cause worry among individuals without a history of brain hemorrhage. "In general, patients with small unruptured intracranial aneurysms and no history of other ruptured aneurysms should be comforted by the prospect of living a normal lifestyle with minimal risk while monitoring the aneurysm," he says.

The NINDS is the nation's principal supporter of research on the brain and nervous system and a lead agency for the Congressionally designated Decade of the Brain. The Institute supports and conducts a broad program of basic and clinical neurological investigations and is part of the National Institutes of Health, located in Bethesda, Maryland.

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Contact: Marcia Vital
301-496-5751
NIH/National Institute of Neurological Disorders and Stroke
9-Dec-1998

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