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Neurosurgeons Find Strong Association Between Cigarette Smoking and Aneurysm Rupture
ROLLING MEADOWS (October 27, 2000) -Neurosurgeons have revealed that cigarette smoking is a significant risk factor for aneurysm rupture. In a study, "Natural History of Unruptured Intracranial Aneurysms: Probablility of and Risk Factors for Aneurysm Rupture," published in the September issue of the Journal of Neurosurgery (scientific publication of the American Association of Neurological Surgeons), neurosurgeons investigated the long-term natural history of unruptured intracranial aneurysms, finding a significant association between cigarette smoking and increased size of an unruptured lesion and subsequent aneurysm rupture. Authors of the study included Seppo Juvela, MD, PhD, Matti Porras, MD, PhD and Kristina Poussa, MD from Helsinki, Finland.
Intracranial aneurysm rupture is a catastrophic event. Each year approximately 30,000 people suffer intracranial aneurysm rupture in the United States; 60% die or are disabled. In addition, approximately half the patients who survive are unable to return to their previous employment or suffer from significant neuropsychological and cognitive deficits. A variety of non-invasive imaging techniques, particularly MRI (magnetic resonance imaging) and MRA (magnetic resonance angiography), now allow physicians to detect even small intracranial aneurysms in otherwise healthy individuals. In view of this, neurosurgeons have attempted to identify and repair intracranial aneurysms before they rupture. This strategy, however, is associated with a small risk to the patient. Consequently there is debate among medical professionals about which patients should undergo repair of unruptured intracranial aneurysms. In addition, it is not clearly known which people are at highest risk for intracranial aneurysm rupture and so should undergo imaging studies to detect these lesions before they become symptomatic.
Intracranial aneurysms are thought to be acquired degenerative lesions that form because of hemodynamic stress from circulating blood, or in a few patients, because of connective tissue diseases. Several studies have shown that larger aneurysms are more likely to rupture. The study by Juvela and colleagues now demonstrates that a modifiable risk factor, cigarette smoking, is significantly associated with aneurysm rupture. This information assists in determining which patients should undergo repair of unruptured aneurysms. In the study, 142 patients with a total of 181 unruptured aneurysms who did not undergo treatment of these lesions were followed from 1956 until 1998 or until death or aneurysm rupture. These patients or their relatives were all interviewed in the outpatient department of the Department of Neurosurgery at Helsinki University Central Hospital, in Helsinki, Finland using a structured questionnaire that included data on height and weight; previous diseases; hospital visits; regular drug use; including analgesic medications, stimulants, and narcotics; approximate intake of coffee, beer, wine and spirits; current and previous smoking status; and family history of intracranial aneurysms. During these 2,575 cumulative-years of patient follow up, there were 33 first time episodes of intracranial aneurysm rupture. Seventeen of these patients died; most from the brain damage from a severe initial hemorrhage. The authors found that three factors: increased aneurysm size, patient age and cigarette smoking were independent predictors for aneurysm rupture.
"The significant association between cigarette smoking and the risk of subsequent rupture of the intact aneurysm strongly suggests that smoking increases the size of an unruptured lesion," said Seppo Juvelo, MD, PhD, a practicing neurosurgeon and member of the American Association of Neurological Surgeons (AANS). "We know that smoking constricts blood vessels, but whether it can cause formation of a new aneurysm remains unknown." The results of this study, however, suggest that unruptured intracranial aneurysms should be treated, provided patient age and the presence of pre-existing diseases do not increase treatment risk. In particular the authors noted that the younger patients and those who smoke should undergo aneurysm treatment by a neurosurgeon. Among those patients who cannot undergo surgery because of medical risk factors, the option to quit smoking is a good alternative to surgery.
The Journal of Neurosurgery is the scientific publication of the American Association of Neurological Surgeons. Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons is a scientific and educational association with nearly 5,800 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are Board-certified by the American Board of Neurological Surgery. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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