Evidence map›Paper›PMID 39945879›Full record

ArticleActa neurochirurgica2025

Treatment of small intracranial aneurysms using the SMALLSS scoring system: a novel system for decision making.

Mira Salih, Michael Young, Thomas B Fodor, Alexander Andreev, Samuel D Pettersson, Joanna M Roy, Basel Musmar, Max Shutran, Phillip Taussky, Christopher S Ogilvy

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Mira SalihNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Michael YoungNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Thomas B FodorNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Alexander AndreevNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Samuel D PetterssonNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Joanna M RoyDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Basel MusmarDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Max ShutranNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Phillip TausskyNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Christopher S OgilvyNeurosurgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. cogilvy@bidmc.harvard.edu.ORCID 0000-0003-4600-8545

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTreatment of unruptured intracranial aneurysms (UIA) less than 7 mm is controversial. We created a scoring system to guide decision making and validated the system utilizing over 700 cases treated with microsurgery or endovascular procedures.

methodsThe scoring system SMALLSS included Size, (4-7 mm: 1 point, < 3.9 mm: 0 point), Multiple aneurysms (yes: 1, no: 0), Anatomic location (posterior: 1, anterior: 0), Lineage- family history of aneurysm (yes:1, no: 0), Lifetime risk (age < 65: 1, age > 65: 0), Smoking history (yes: 1, no: 0 ), Shape (irregular:1, smooth:0 ). Validation of this system was performed through retrospective review of prospectively maintained data for UIA patients treated between 2014 and 2021. We then performed an external validation of a cohort of 200 small aneurysms < 7 mm treated at a high volume cerebrovascular center.

resultsA total of 1152 cases with unruptured intracranial aneurysms were treated over the study interval, of which 771 aneurysms (66.9%) were under 7 mm, with the majority (64.3%) having SMALLSS score more than 2. Serious neurologic complications occurred in 18 out of 771 aneurysms (2.33%) of which 4 were hemorrhagic and 14 were ischemic. The obliteration rate was 98% in microsurgery group, 89.7% in endovascular group. During this same interval, 1126 patients with aneurysms < 7 mm were evaluated and not offered treatment, with 74.7% SMALLSS scores of 2 and under. External validation data showed no significant deviations from our cohort with 150 out of 200 aneurysms (75%) with a SMALLSS score of 2 or greater.

conclusionThe SMALLSS scoring system can be a good tool to guide treatment decision making for patients with small UIA. The risk of treatment did not increase with the projected increased risk of rupture and overall high obliteration rates were achieved with endovascular and surgical techniques.

Indexed as

Clinical Decision-MakingEndovascular ProceduresIntracranial AneurysmMicrosurgeryAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeEndovascular treatmentMicrosurgeryNatural historyOutcomesSmall aneurysmsSMALLSS score

Identifiers

PMID39945879
PMCPMC11825591

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.