Nima Etminan1, Kerim Beseoglu, Daniel L Barrow, Joshua Bederson, Robert D Brown, E Sander Connolly, Colin P Derdeyn, Daniel Hänggi, David Hasan, Seppo Juvela, Hidetoshi Kasuya, Peter J Kirkpatrick, Neville Knuckey, Timo Koivisto, Giuseppe Lanzino, Michael T Lawton, Peter LeRoux, Cameron G McDougall, Edward Mee, J Mocco, Andrew Molyneux, Michael K Morgan, Kentaro Mori, Akio Morita, Yuichi Murayama, Shinji Nagahiro, Alberto Pasqualin, Andreas Raabe, Jean Raymond, Gabriel J E Rinkel, Daniel Rüfenacht, Volker Seifert, Julian Spears, Hans-Jakob Steiger, Helmuth Steinmetz, James C Torner, Peter Vajkoczy, Isabel Wanke, George K C Wong, John H Wong, R Loch Macdonald. 1. From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine/ Barnes Jewish Hospital, St Louis, MO (C.P.D.); Departments of Neurosurgery (D. Hasan) and Epidemiology (J.C.T.), University of Iowa, Iowa City; Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland (S.J.); Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan (H.K.); Neurosurgery Unit, Department of Clinical Neurosciences, Cambridge University Hospitals Trust, University of Cambridge, Cambridge, UK (P.J.K.); Sir Charles Gairdner Hospital, Western Australia (N.K.); Neurosurgery/ NeuroCenter, Kuopio University Hospital, University of Eastern Finland, Finland (T.K.); Department of Neurological Surgery, University of California, San Francisco (M.T.L.); Brain and Spine Center, Lankenau Medical Center, Wynnewood, PA (P.L.); Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (C.G.M.); Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand (E.M.); Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN (J.M.); Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK (A.M.); Division of Neurosurgery, Macquarie University, Sydney, Australia (M.K.M.); Department of Neurosurgery, National Defense Medical College, Tokyo, Japan (K.M.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (A.M.);
Abstract
BACKGROUND AND PURPOSE: To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields involved in research and treatment of UIAs. METHODS: After composition of the research group, a Delphi consensus was initiated to identify and rate all features, which may be relevant to assess UIAs and their treatment by using ranking scales and analysis of inter-rater agreement (IRA) for each factor. IRA was categorized as very high, high, moderate, or low. RESULTS: Ultimately, 39 specialists from 4 specialties agreed (high or very high IRAs) on the following key factors for or against UIA treatment decisions: (1) patient age, life expectancy, and comorbid diseases; (2) previous subarachnoid hemorrhage from a different aneurysm, family history for UIA or subarachnoid hemorrhage, nicotine use; (3) UIA size, location, and lobulation; (4) UIA growth or de novo formation on serial imaging; (5) clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events from UIAs); and (6) risk factors for UIA treatment (patient age and life expectancy, UIA size, and estimated risk of treatment). However, IRAs for features rated with low relevance were also generally low, which underlined the existing controversy about the natural history of UIAs. CONCLUSIONS: Our results highlight that neurovascular specialists currently consider many features as important when evaluating UIAs but also highlight that the appreciation of natural history of UIAs remains uncertain, even within a group of highly informed individuals.
BACKGROUND AND PURPOSE: To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields involved in research and treatment of UIAs. METHODS: After composition of the research group, a Delphi consensus was initiated to identify and rate all features, which may be relevant to assess UIAs and their treatment by using ranking scales and analysis of inter-rater agreement (IRA) for each factor. IRA was categorized as very high, high, moderate, or low. RESULTS: Ultimately, 39 specialists from 4 specialties agreed (high or very high IRAs) on the following key factors for or against UIA treatment decisions: (1) patient age, life expectancy, and comorbid diseases; (2) previous subarachnoid hemorrhage from a different aneurysm, family history for UIA or subarachnoid hemorrhage, nicotine use; (3) UIA size, location, and lobulation; (4) UIA growth or de novo formation on serial imaging; (5) clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events from UIAs); and (6) risk factors for UIA treatment (patient age and life expectancy, UIA size, and estimated risk of treatment). However, IRAs for features rated with low relevance were also generally low, which underlined the existing controversy about the natural history of UIAs. CONCLUSIONS: Our results highlight that neurovascular specialists currently consider many features as important when evaluating UIAs but also highlight that the appreciation of natural history of UIAs remains uncertain, even within a group of highly informed individuals.
Authors: Nima Etminan; Rita Dreier; Bruce A Buchholz; Kerim Beseoglu; Peter Bruckner; Christian Matzenauer; James C Torner; Robert D Brown; Hans-Jakob Steiger; Daniel Hänggi; R Loch Macdonald Journal: Stroke Date: 2014-04-29 Impact factor: 7.914
Authors: Philippe Bijlenga; Akio Morita; Nerissa U Ko; J Mocco; Sandrine Morel; Yuichi Murayama; Marieke J H Wermer; Robert D Brown Journal: Neurocrit Care Date: 2019-06 Impact factor: 3.210
Authors: W Brinjikji; Y-Q Zhu; G Lanzino; H J Cloft; M H Murad; Z Wang; D F Kallmes Journal: AJNR Am J Neuroradiol Date: 2015-11-26 Impact factor: 3.825
Authors: X Liu; H Haraldsson; Y Wang; E Kao; M Ballweber; A J Martin; C E McCulloch; F Faraji; D Saloner Journal: AJNR Am J Neuroradiol Date: 2021-06-24 Impact factor: 4.966