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NEUROLOGY 1986;36:1335
© 1986 American Academy of Neurology

Decision analysis of the management of incidental intracranial saccular aneurysms

H. van Crevel, MD, J.D.F. Habbema, PhD and R. Braakman, MD

Department of Neurology (Dr. van Crevel), Academic Medical Center, Amsterdam; the Department of Public Health and Social Medicine (Dr. Habbema), Erasmus University, Rotterdam; and the Department of Neurosurgery (Dr. Braakman), Academic Hospital Dijkzigt, Rotterdam, The Netherlands.

We used decision analysis to approach the dilemma "surgery or not?" in patients with incidental intracranial saccular aneurysms. To decide if a patient should undergo surgery, the following factors are of primary importance: age and general health of the patient, chance of rupture of the aneurysm, surgical mortality and morbidity, and patient preference for immediate and long-term risks. In a fictitious patient (a woman of 45 with migraine, otherwise healthy), surgery was the option with the greatest expected utility. Sensitivity analysis showed the influence of different factors. Other patients are also discussed, and "break-even" points for age versus surgical results are given.

Address correspondence and reprint requests to Dr. van Crevel, Department of Neurology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands.

Accepted for publication February 4, 1986.




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