Document Detail


Practical decision-making in the treatment of unruptured cerebral aneurysm in Japan: the U-CARE study.
MedLine Citation:
PMID:  20861620     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Decision-making during the management of unruptured cerebral aneurysms is a delicate process for both neurosurgeons and patients. Guidelines are evidence-based references that can aid in making decisions. However, neurosurgeons do not always follow guidelines in clinical practice. The purpose of this study is to verify the hypothesis that there is substantial dissociation between treatment guidelines and practical decision-making due to a bias in treatment selection for unruptured cerebral aneurysms. This bias is dependent upon clinician-driven factors such as experience and specialty, and patient-driven factors such as patient preference.
METHODS: This study was performed using internet questionnaires. A total of 282 randomly selected, qualified Japanese neurosurgeons (out of approx. 6,000 registered neurosurgeons), including 45 endovascular specialists, participated in this study. Radiological and demographic data from 88 cases of unruptured cerebral aneurysm were opened on the Web. Participating neurosurgeons decided on the treatment for each case (clipping, coiling or observation).
RESULTS: Variations in treatment selection were not significant between neurosurgeons and endovascular specialists, except for aneurysms such as anterior choroidal artery aneurysm. However, contrary to the guidelines, aneurysms larger than 10 mm tended to be treated conservatively because the risk of treatment is high, while aneurysms smaller than 5 mm in diameter were often selected for intervention (clipping or coiling).
CONCLUSIONS: This study revealed that in real-world clinical practice, physicians are not always faithful to the current guidelines. In making practical treatment decisions for unruptured cerebral aneurysms, the patient's will and the recognition of unavoidable, treatment-related risks seriously influence neurosurgeons' decisions.
Authors:
Yukinori Akiyama; Kiyohiro Houkin; Kazuhiko Nozaki; Nobuo Hashimoto
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-22
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  30     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2010  
Date Detail:
Created Date:  2010-10-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  491-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 S. Karger AG, Basel.
Affiliation:
Department of Neurosurgery, Sapporo Medical University, S1 W16 Chuo-ku, Sapporo, Hokkaido, Japan.
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