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Vascular neurology
Outcomes of medical and surgical management in infectious intracranial aneurysms: a multicenter cohort analysis
  1. Ali M Alawieh1,
  2. Laurie Dimisko1,
  3. Youssef M Zohdy1,
  4. Andrew B Koo2,
  5. Hassan Saad1,
  6. Bachar El Baba1,
  7. Sarah Newman2,
  8. Jonathan A Grossberg3,
  9. Charles Matouk2,
  10. C Michael Cawley2,
  11. Gustavo Pradilla2,
  12. Andrew Reisner4,
  13. W Christopher Fox5,
  14. Carlos Perez-Vega6,
  15. Jan-Karl Burkhardt7,
  16. Mohamed Salem7,
  17. Pascal Jabbour1,
  18. Kareem El Naamani1,
  19. Richard F Schmidt1,
  20. M Reid Gooch1,
  21. Robert M Starke1,
  22. Ahmed Abdelsalam1,
  23. Victor M Lu1,
  24. Michael Levitt1,
  25. Reda M Chalhoub1,
  26. Firas Kobeissy1,
  27. Alejandro M Spiotta1,
  28. Daniel Barrow1,
  29. Brian M Howard1
  1. 1Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
  3. 3Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4Children’s Healthcare Atlanta, Atlanta, Georgia, USA
  5. 5Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
  6. 6Neurologic Surgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
  7. 7Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Youssef M Zohdy; youssef.ismail{at}emory.edu; Dr Ali M Alawieh; ali.mostafa.alawieh{at}emory.edu; Dr Brian M Howard; brian.howard{at}emory.edu

Abstract

Introduction Infectious intracranial aneurysms (IIAs) are rare but serious complications of systemic infections, particularly infective endocarditis. These aneurysms are prone to rupture, leading to significant morbidity and mortality. Management strategies lack consensus due to the rarity of the condition and reliance on small case series. This study examines the clinical management of IIAs using data from a large multicenter cohort.

Methods A retrospective registry-based cohort study was conducted across 11 tertiary care centers in the USA between 2018 and 2023. Patients with IIAs were identified based on clinical and radiographic criteria. The primary outcome was treatment failure defined as persistence, growth, or rupture of the aneurysm. Secondary outcomes were mortality and the modified Rankin Scale (mRS) score at 90 days and 1 year. Multivariate logistic regressions were used to identify outcome predictors.

Results A total of 104 patients with 166 aneurysms were included, with a median age of 43 years. Medical management was successful in 56% of cases, with failure often within 18 days of initiation. Predictors of failure included younger age, larger aneurysm size, and rupture at presentation. Surgical and endovascular interventions achieved higher success rates with better outcomes. At 90 days, 57% of patients achieved functional independence (mRS 0–2), while the mortality rate was 24%.

Conclusion This study highlights the limitations of medical management for IIAs and underscores the need for early surgical or endovascular intervention in high-risk patients. Outcome predictors aid clinical decision-making, optimizing patient management. Further research is needed to standardize management guidelines for IIAs.

  • Aneurysm
  • Infection

Data availability statement

Data are available upon reasonable request. Anonymized data not published within this article will be made available by request from any qualified investigator. Investigators interested in working with the data should contact the corresponding author.

https://doi.org/10.1136/jnis-2025-023421

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    Data availability statement

    Data are available upon reasonable request. Anonymized data not published within this article will be made available by request from any qualified investigator. Investigators interested in working with the data should contact the corresponding author.

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    Footnotes

    • X @JAGrossbergMD, @wchrisfox, @carlosperezv, @PascalJabbourMD, @DrMichaelLevitt, @ChalhoubReda, @BrianHoward_MD

    • Contributors AMA, LD, and BMH conceptualized the study and designed the methodology. AMA, LD, and BEB performed the data collection. AMA, LD, and YMZ conducted data analysis and interpretation. AMA and YMZ contributed to the statistical analysis. AMA and LD wrote the original draft of the manuscript. The manuscript was reviewed and edited by YMZ, ABK, HS, SN, JAG, CM, CMC, GP, AR, WCF, CP-V, J-KB, MS, PJ, KEN, RFS, MRG, RMS, AA, VML, ML, RMC, FK, AMS, DB, BMH. AMA, FK, AMS, DB, and BMH supervised the study. All authors read and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests AMA received grant funding from Department of Defense, Department of Veterans Affairs, Abbott, Inc, and Penumbra, Inc. which is unrelated to this work. MRL: Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Aeaean Advisers, Metis Innovative, Genomadix, AIDoc and Arsenal Medical; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, Synchron and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.