Management of patients with an unruptured intracranial aneurysm and a history of malignancy

BACKGROUND: Management of a patient with an unruptured intracranial aneurysm (UIA) who has a history of malignancy can be challenging due to considerations related to the natural history of the aneurysm and risk of recurrence or progression of malignancy. The current study presents our experience with both conservative management and interventional treatment of patients with UIAs and a remote or recent history of cancer. METHODS: Consecutive patients with a history of malignancy and UIA were classified into the following groups: Group I (diagnoses of both UIA and cancer within 3 years) and Group II (known cancer with new UIA diagnosed ≥3 years after cancer). Patient demographics, clinical characteristics, aneurysm/treatment characteristics, and outcomes were collected prospectively. We studied the following outcomes: perioperative and mid-/long-term complications, aneurysm rupture, retreatment/recurrence rates, long-term neurological outcome, and possible impact of cancer history on decision-making for treatment. RESULTS: A total of 122 patients were included in this study (55 in Group I and 67 in Group II). Patients in Group I underwent aneurysm treatment significantly less often than those in Group II (20.0% versus 46.3%, P=0.002). There was no difference in neurological morbidity rates between the two groups after a mean follow-up of 22.3 months (3.6% versus 3.0%, P=0.29). Overall, untreated patients experienced an annualized rupture rate of 1.6% (95% CI=0.0%-3.4%, 3/187.6 ruptures/person years). CONCLUSIONS: Patients with an UIA and a history of cancer should be considered for management with either conservative management or invasive techniques. The optimal UIA management is defined on a case-by-case basis carefully comparing the prognosis of the patient’s malignancy with the natural history of the aneurysm and the risk of interventional treatment.