A mathematical model of the natural history of intracranial aneurysms: quantification of the benefit of prophylactic treatment

Journal of Neurosurgery
Yuhei Yoshimoto

Abstract

The International Study of Unruptured Intracranial Aneurysms (ISUIA) data raised new controversy regarding the threshold size that requires treatment. In particular, this study has been criticized for disagreeing with previous epidemiological data. The author first used a Markov model to simulate the natural history of intracranial aneurysms, making three key assumptions based on prospective ISUIA data and other recent reports: that the rate of de novo aneurysm formation is constant after the age of 20 years; that unruptured aneurysms gain volume at a constant rate; and that unruptured aneurysms rupture at a volume-dependent rate. Next, he expressed outcomes for patients with unruptured aneurysms in terms of expected number of quality-adjusted life years (QALY) and compared two hypothetical cohorts, one receiving treatment and the other not being treated. These assumptions enabled the construction of a mathematical model with epidemiologically compatible findings. The benefits of treatment for unruptured aneurysms were highly influenced by aneurysm size and were calculated as -0.28, 0.25, and 1.07 QALY for patients having unruptured aneurysms with diameters of 7, 10, and 13 mm, respectively. Under the author's assumptions, the ...Continue Reading

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Citations

Jul 4, 2012·Pituitary·Satoru OshinoYouichi Saitoh
Jun 19, 2009·Biomedical Engineering Online·Liang-Der Jou, Michel E Mawad
Aug 2, 2008·Journal of Neurosurgery·Hendrik KoffijbergGabriel J E Rinkel
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Aug 29, 2016·World Neurosurgery·Kaoru AishimaYuhei Yoshimoto
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May 24, 2012·European Journal of Anaesthesiology·Markus Weiss, Thomas Engelhardt

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