Paraclinoid ANeurysm Prospectively Driven ObseRvational Analysis (PANDORA) Study

Brief Summary: The optimal consensus concerning treatment of incidental small paraclinoid unruptured intracranial aneurysms (UIAs) remains controversial. The aim of this prospective study is to reveal the natural history of small paraclinoid UIAs with the goal of informing the treatment plan.

Detailed Description: A prospective observational study will be conducted in 13 Korean centers enrolling a consecutive series of 645 patients with small paraclinoid unruptured intracranial aneurysms (UIAs) from 2015 to 2017.

The investigators defined the cohort population as adults(20 years old or more) with small (less than 5mm) unruptured paraclinoid aneurysm. To determine the growth rate and risk factors, the angiographic features based on MRA or CTA(ex) size, arterial relationship, multiplicity)and the clinical characteristics (ex) age, hypertension (HTN), diabetes mellitus(DM), Hyperlipidemia, smoking) are recorded at initial visit, 1 year, 2years, 3years, and 5years.

The cumulative risk and the risk factors of aneurysmal rupture and growth will be analysed.

Recruitment & Eligibility

Inclusion Criteria

Patients with newly diagnosed small unruptured paraclinoid aneurysms who agreed to participate.
20years old or more
less than 5mm in maximum diameter
neurological status of patients should be satisfied with less than modified Rankin score 2 or more than 70 in Karnofsky performance score

Exclusion Criteria

patients had previous subarachnoid hemorrhage that could be related to the rupture of paraclinoid aneurysm.
traumatic, infectious or dissecting aneurysms
fusiform aneurysms
aneurysms that related to other vascular disease or brain tumor
aneurysm that associated with the atherosclerotic change of a parent artery

Primary Outcome Measures

Name	Time	Method
Number of increased maximal diameter of enrolled paraclinoid aneurysms on follow up MRA or CTA	within 5years after enrollment	If, the maximal diameter(in mm) of aneurysm which is measured by 1 neurosurgeon and 1 neuroradiologist on follow up MRA or CTA (1,2,3,5 year follow up) is 1.5 times bigger than on initial MRA or CTA, investigators will decide that the aneurysm is increased.
Number of rupture of enrolled paraclinoid aneurysms	within 5years after enrollment	annual rupture rate

Secondary Outcome Measures

Name	Time	Method
Number of participants with worsened modified Rankin scale score	within 5years after enrollment	from 0(No symptom at all) to 6(Dead)
Treatment(due to growth or rupture) rate of enrolled aneurysms	within 5years after enrollment
Mortality rate of enrolled patients(related to rupture of aneurysm or not)	within 5years after enrollment	death due to ruptured aneurysm
Number of participants with worsened Karnofsky Performance Status scale	within 5years after enrollment	from 0(Dead) to 100(Normal)

Locations (8): Seoul National University Hospital
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Seoul, Korea, Republic of
KangWon National University Hospital
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Chuncheon, Kangwon, Korea, Republic of
SMG-SNU Boramae Medical Center
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Seoul, Korea, Republic of
DongGuk University
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Ilsan, Kyungkido, Korea, Republic of
Gyeongsang National University Hospital
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Jinju, Gyeongsangnam-do, Korea, Republic of
Sungkyunkwan University Samsung Medical center
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Seoul, Kangnam, Korea, Republic of
Soonchunhyang University Hospital - Seoul
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Seoul, Korea, Republic of
Seoul National University Bundang Hospital
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Seongnam-si, Kyungkido, Korea, Republic of