Jean Raymond1. 1. Interventional Neuroradiology Research Unit, Department of Radiology, Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Canada. dr_jean_raymond@hotmail.com
Abstract
PURPOSE OF REVIEW: The review critically appraises the available evidence and current rationale for treating incidental intracranial aneurysms. RECENT FINDINGS: The rationale for treating incidental intracranial aneurysms uses comparisons between the so-called natural history, provided in a recent meta-analysis, and risks of treatments. Some risk factors for ruptures were identified (age >60, female sex, size >5 mm, posterior circulation aneurysms), but study quality is poor and relative risks are modest, of borderline statistical significance. SUMMARY: The medical literature cannot provide reliable numerical data of sufficient precision and quality to feed mathematical models of prediction of potential treatment benefits. Hence, the rationale fails to justify increasingly used treatments. A different approach using randomized trials is now in order.
PURPOSE OF REVIEW: The review critically appraises the available evidence and current rationale for treating incidental intracranial aneurysms. RECENT FINDINGS: The rationale for treating incidental intracranial aneurysms uses comparisons between the so-called natural history, provided in a recent meta-analysis, and risks of treatments. Some risk factors for ruptures were identified (age >60, female sex, size >5 mm, posterior circulation aneurysms), but study quality is poor and relative risks are modest, of borderline statistical significance. SUMMARY: The medical literature cannot provide reliable numerical data of sufficient precision and quality to feed mathematical models of prediction of potential treatment benefits. Hence, the rationale fails to justify increasingly used treatments. A different approach using randomized trials is now in order.
Authors: Nima Etminan; Robert D Brown; Kerim Beseoglu; Seppo Juvela; Jean Raymond; Akio Morita; James C Torner; Colin P Derdeyn; Andreas Raabe; J Mocco; Miikka Korja; Amr Abdulazim; Sepideh Amin-Hanjani; Rustam Al-Shahi Salman; Daniel L Barrow; Joshua Bederson; Alain Bonafe; Aaron S Dumont; David J Fiorella; Andreas Gruber; Graeme J Hankey; David M Hasan; Brian L Hoh; Pascal Jabbour; Hidetoshi Kasuya; Michael E Kelly; Peter J Kirkpatrick; Neville Knuckey; Timo Koivisto; Timo Krings; Michael T Lawton; Thomas R Marotta; Stephan A Mayer; Edward Mee; Vitor Mendes Pereira; Andrew Molyneux; Michael K Morgan; Kentaro Mori; Yuichi Murayama; Shinji Nagahiro; Naoki Nakayama; Mika Niemelä; Christopher S Ogilvy; Laurent Pierot; Alejandro A Rabinstein; Yvo B W E M Roos; Jaakko Rinne; Robert H Rosenwasser; Antti Ronkainen; Karl Schaller; Volker Seifert; Robert A Solomon; Julian Spears; Hans-Jakob Steiger; Mervyn D I Vergouwen; Isabel Wanke; Marieke J H Wermer; George K C Wong; John H Wong; Gregory J Zipfel; E Sander Connolly; Helmuth Steinmetz; Giuseppe Lanzino; Alberto Pasqualin; Daniel Rüfenacht; Peter Vajkoczy; Cameron McDougall; Daniel Hänggi; Peter LeRoux; Gabriel J E Rinkel; R Loch Macdonald Journal: Neurology Date: 2015-08-14 Impact factor: 9.910