Neurologia Medico-Chirurgica · Published 2026-05-14 · DOI 10.2176/jns-nmc.2025-0241
Fumihiro MATANO, Yasuo MURAI, Takayuki MIZUNARI, Minoru IDEGUCHI, Kenta KOKETSU, Takehiko SASAKI, Toru NISHI, Shigeo YAMASHIRO, Isao DATE, Tomohito HISHIKAWA, Fusao IKAWA, Shigeyuki SAKAMOTO, Katsumi TAKIZAWA, Tohru KOBAYASHI, Kentaro MORI, Junta MOROI, Toshiaki OSATO, Masanori SUZUKI, Hiromu HADEISHI, Yoshiaki SHIOKAWA, Atsushi SAITO, Masaaki UNO, Shigeo SORA, Akitsugu KAWASHIMA, Tohru MIZUTANI, Tomonori TAMAKI, Rokuya TANIKAWA, Akio MORITA
It remains unclear whether frailty and white matter lesions are risk factors for surgical treatment of unruptured intracranial aneurysms in older adults. We conducted a prospective multicenter study of 397 patients aged 60 years with unruptured intracranial aneurysms enrolled from 20 hospitals in Japan. Unruptured intracranial aneurysms were treated by either microsurgical clipping or endovascular treatment according to institutional protocols. The primary endpoint was functional outcome at discharge assessed using the modified Rankin scale (mRS). Poor outcome was defined as a deterioration of 1 or more points in the mRS score at discharge compared with the preoperative baseline. Unruptured intracranial aneurysm size ranged from 2.1 to 26 mm (mean, 6.93 mm). Poor outcome occurred in 52 patients (13.1%). There was no significant association between poor outcome and age (p = 0.089) or treatment modality (clipping vs. coiling, p = 0.4739). In multivariate regression analysis, poor outcome was significantly associated with larger unruptured intracranial aneurysm size (p = 0.033), higher Clinical Frailty Scale score (p = 0.006), higher preoperative mRS score (p = 0.039), lower hemoglobin level (p = 0.016), absence of regular exercise (p = 0.046), slower walking speed (p = 0.002), severe white matter lesions (p = 0.001), and lower intraoperative blood pressure (p = 0.032). Severe white matter lesions were associated with a higher risk of postoperative ischemia (p 0.042) and intracranial hemorrhage (p = 0.0017). These findings indicate that preoperative frailty and severe white matter lesions are significant predictors of poor outcomes after unruptured intracranial aneurysm surgery in older adults. Trial registration: umin.ac.jp/ctr Identifier: UMIN 000029977
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MATANO, F., MURAI, Y., MIZUNARI, T., et al. (2026). Frailty and Severe White Matter Lesions Are Risk Factors for Surgical Treatment for Unruptured Cerebral Aneurysm in Older Adults. Neurologia Medico-Chirurgica. https://doi.org/10.2176/jns-nmc.2025-0241