Background: The lack of consensus in the management of unruptured intracranial aneurysms (UIA) has resulted in a variety of different clinical practices. The aim of this study is to analyze these different practices.
Methods: A questionnaire concerning the management of UIA was mailed out to French neurosurgeons (NS) and neuroradiologists (NR). Eighteen responses from 17 teams of NS and 23 responses from 19 teams of NR were included in our analysis.
Results: In making a therapeutic decision, about three-quarters of both NR and NS take into account the age of the patient and all of our responders except one consider the aneurysm's morphology, especially its size and neck structure. Pinpointing the location of the aneurysm is an important factor for 61% of NR and 40% of NS. Information concerning the risk of aneurysm rupture and the risks of treatment is routinely given to the patient orally and, sometimes, in writing. The follow-up of UIA treated by NR usually consists of one X-ray angiography and several MR angiographic (MRA) films taken over a period of at least five years and, sometimes, for the rest of the patient's life (22%). The follow-up after surgical treatment mainly comprises X-ray angiography for a limited period of time-usually from five to ten years. The follow-up of untreated aneurysms is usually by either MRA or angioCT. For most NR, the duration of follow-up is long and, sometimes, unlimited. For NS, the duration is more difficult to pinpoint: the response was indeterminate in 28 and 33% gave no response at all. If the first screening tests negative, 44% of NS and 61% of NR propose a repeat screening.
Conclusion: Given the differences in the management of UIA as revealed by this survey, a multidisciplinary approach that combines the various clinical practices may be the best way forward.