Risk analysis of treatment of unruptured aneurysms

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Abstract
OBJECTIVES To calculate the expected number of life-years saved by surgical treatment of unruptured intracranial aneurysms at ages over 20 years. METHODS An actuarial risk analysis of the treatment of unruptured intracranial aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms (ISUIA). The benefits of operative treatment are calculated in terms of average life-years saved. RESULTS Results are presented as graphs of life-years saved or lost against age at the time of operative treatment for three groups of aneurysms: those under 10 mm in diameter with no history of subarachnoid haemorrhage (SAH) from another aneurysm, those under 10 mm in diameter and a history of previous SAH from a different aneurysm, and those over 10 mm in diameter. Life-years are lost at all ages in the group under 10 mm with no history of SAH. For the group under 10 mm with a history of SAH about 4 years are saved at age 20 declining to 0 at around age 50. For aneurysms 10 mm or more in diameter about 8 life-years are saved at age 20 declining to 0 at around 50. CONCLUSIONS Clipping of unruptured aneurysms under 10 mm in diameter with no history of subarachnoid haemorrhage is not justified on actuarial grounds. Intervention in other unruptured aneurysms produces benefits in life expectancy up to the age of 50. There may be subgroups of aneurysms in which larger benefits exist.