R. Leblanc et al., ANGIOGRAPHIC SCREENING AND ELECTIVE SURGERY OF FAMILIAL CEREBRAL ANEURYSMS - A DECISION-ANALYSIS, Neurosurgery, 35(1), 1994, pp. 9-18
Up to 6% of cerebral aneurysms may be familial. Because the pattern of
inheritance and the prevalence of aneurysms within families are unkno
wn, the management of family members at risk of harboring a cerebral a
neurysm is currently empirical. We established the prevalence of aneur
ysms in the second generation of individuals with familial cerebral an
eurysms and determined the possible benefit of angiographic screening
and elective surgery of such individuals by using a simple decision an
alysis model. Four consecutive families were identified in whom the mo
ther and a child had a ruptured cerebral aneurysm. A total of 19 sibli
ngs at risk in the second generation were identified. Fifteen underwen
t elective cerebral angiography: one had a cerebral aneurysm and two h
ad an infundibulum at the origin of the posterior communicating artery
. Including the previously known aneurysms, the prevalence of aneurysm
s in the second generation was thus established at 29.4%. A decision a
nalysis was performed with 2% as the annual risk of rupture, 72.7% as
the risk of death or disability with rupture, 0.1% as the risk of angi
ography, and 6.5% as the risk of surgery. The benefit in years of surv
ival free of sequelae resulting from angiographic screening and electi
ve surgery (intervention) over natural history was computed for life e
xpectancy corresponding to each quinquennial age group from age 15 to
100 years. Intervention equaled natural history, in terms of years of
survival expected with each choice, at a life expectancy of 10.6 years
, corresponding to age 76.5 years for men and 80 years for women, and
produced a net gain of at least 1 year for patients whose life expecta
ncy was 32 years or more, corresponding to age 53.5 years for women an
d 49 years for men. Greater benefit was achieved with increasing life
expectancy (younger age). The prevalence of aneurysms in the second ge
neration when a mother and child have an aneurysm is 29.4%. interventi
on produces a benefit of at least 1 year of survival free of sequelae
over natural history in such individuals their life expectancy is 32 y
ears or more.