Natural History of Ruptured But Untreated Intracranial Aneurysms Interview with:
Dr. Miikka Korja
Chief Innovation Officer
Associate Professor of Neurosurgery
HUS, Helsinki University Hospital What is the background for this study? What are the main findings?

Response: Helsinki University Hospital, one of the largest hospital organizations in industrialized countries, has a very long history in conducting studies on brain aneurysms and aneurysmal subarachnoid hemorrhage. The one and only study on the natural history of ruptured aneurysms has also been conducted in Helsinki 50 years ago (published in 1967). The term “natural history” refers to an approach where the cause of a patient’s disease is not treated at all. In this case, it means that ruptured aneurysms in patients with devastating brain hemorrhage, aneurysmal subarachnoid hemorrhage, were left untreated.

Therefore, these patients have a high risk of a rebleeding from the once ruptured aneurysm. As ruptured aneurysms are nowadays unexceptionally treated, if the patient survives the primary bleeding event, such natural history studies are impractical to conduct.

We wanted to update the 50 years old data by using a historical patient registry. Back in the old days, many of aneurysmal subarachnoid hemorrhage patients were not treated because for example surgery was considered too risky or patients were classified as too old for surgery. By using the historical data, we showed that aneurysmal SAH, if not treated, is even more devastating disease than believed. Based on our results, we can state that 75-89% of today’s patients die in a year without treatments. What should readers take away from your report?

Response: As aneurysmal subarachnoid hemorrhage is truly a fatal disease without endovascular or surgical closure of the ruptured aneurysm, it is of utmost importance to diagnose these patients in the first place. In other words, when patients experience symptoms of aneurysmal SAH (most often exceptionally strong and sudden-onset headache), and seek medical advice, it is important to exclude the possibility of aneurysmal subarachnoid hemorrhage. If this bleed is misdiagnosed, the patient has a very high likelihood of dying from a new bleed. What recommendations do you have for future research as a result of this study?

Response: We believe that it is basically impossible to conduct a similar study in industrialized countries in future, as aneurysmal SAH patients are nowadays always treated. Therefore, this data helps doctors to explain to subarachnoid hemorrhage patients and their relatives the importance of acute surgical or endovascular treatments. In future, in general, we all need to focus on prevention. How we can prevent the birth and rupture of intracranial aneurysms.

No Disclosures Thank you for your contribution to the community.


Natural History of Ruptured but Untreated Intracranial Aneurysms
Originally published March 1, 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 8, 2017 by Marie Benz MD FAAD