Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: Proposal of an international research group

Nima Etminan*, 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. MoccoAndrew 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

82 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1523-1530
Number of pages8
Issue number5
Publication statusPublished - May 2014


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