Korean J Cerebrovasc Surg.  2011 Dec;13(4):279-290.

Guidelines for the Management of Unruptured Intracranial Aneurysm

Affiliations
  • 1Department of Neurosurgery, Kwandong University College of Medicine, Myongji Hospital, Goyang, Korea.
  • 2Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Neurosurgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea.
  • 4Department of Neurosurgery, College of Medicine, Soonchunhyang University Hospital, Seoul, Korea.
  • 5Department of Neurosurgery, Seoul Veterans Hospital, Seoul, Korea.
  • 6Department of Neurosurgery, College of Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
  • 7Department of Neurosurgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea.
  • 8Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 9Department of Neurology, Inha University Hospital, Incheon, Korea.
  • 10Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 11Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 12Department of Neurology, College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 13Department of Neurology, Seoul National University Hospital, Seoul, Korea.
  • 14Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea.
  • 15Department of Neurology, Inje University, Ilsan Paik Hospital, Goyang, Korea.
  • 16Department of Neurosurgery, Sungkyunkwan University Samsung Medical Center, Seoul, Korea.
  • 17Department of Neurosurgery, Gyeongsang National University Hospital, Jinju, Korea. gnuhpis@gnu.ac.kr
  • 18Quality Assurance/Guideline Committee of the Korean Society of Cerebrovascular Surgeons, Korea.

Abstract

Intracranial aneurysmal rupture causes subarachnoid hemorrhage which usually leads to fatality or severe disability. Treatment of unruptured intracranial aneurysms (UIAs) can substantially reduce the risk of rupture and prevent the grave consequences, but the risk of prophylactic treatment cannot be ignored. UIAs have diverse characteristics and management strategy needs to be tailored according to their location, size and clinical status. In the absence of level I evidence, the treatment guidance often relied on expert's opinions and experience. Knowledge of the natural course and management risks of individual aneurysms can help to guide treatment decision, but the natural history is still controversial and risks are not clearly defined. The Korean Society of Cerebrovascular Surgeons (KSCVS) decided to issue a Korean version of UIA management guideline as a framework for the treatment decision and as a basis for future studies, following 'Guideline Development Manual' of the Clinical Research Center for Stroke (CRCS). The organized committee systematically reviewed relevant literature and major guidelines published between January 2000 and July 2010 and took a developmental strategy of adaptation rather than de novo methods. On the basis of interpretation of the published evidences, recommendations were synthesized, and the level of evidence and the grade of recommendation were determined using the methods adapted from those of the US Agency for Healthcare Policy and Research and CRCS. The current guideline focuses on three domains of natural history, diagnosis and treatment of UIAs. The hierarchy of evidence and the recommendation grading indicate the current level by the literature and do not indicate the necessity or the prohibition of a certain clinical practice. Accordingly, this guideline cannot provide the answer for every clinical situation and should not take precedence over the clinical judgment of responsible physicians for individual patients. The final judgment regarding the care of a particular patient must be made by the physician and patient in light of circumstances specific to that patient. This is the first version of the UIA management guideline in Korea and new evidences will be timely and continuously updated in the future guidelines.

Keyword

Unruptured Intracranial Aneurysm; Guideline; Natural History; Diagnosis; Management

MeSH Terms

Aneurysm
Calcium Hydroxide
Delivery of Health Care
Humans
Intracranial Aneurysm
Judgment
Korea
Light
Natural History
Risk Management
Rupture
Stroke
Subarachnoid Hemorrhage
Zinc Oxide
Calcium Hydroxide
Zinc Oxide
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