Talk:Intracranial aneurysm

this article was cut and pasted word for word from [1] Kingturtle 03:18 May 2, 2003 (UTC)

No it wasn't. 1) The page was cut and pasted and then modified. 2) This text appears on the page: "All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated." Hence, no copyright violation. Lukobe

Wikified and Vasospasm Edits

• Added headers, restructured a little.
• Changed the rupture rate number. This is a complex issue. I think the 4% per year is more appropriate for AVM's rather than aneurysms. The rate varies widely with aneurysm size, and I think it would be appropriate to go into that further. The bottom line is that any aneurysm, however small, can rupture, that is why at our institution we don't stratify by size, we just quote 1.3% per year.
• Vasospasm: Big topic, I only touched upon it a little. Triple-H therapy is contentious these days, though everyone agrees that hypotension is bad.
• Citations: I honestly intended to site, linking to PubMed, but for some reason the PubMed server doesn't seem to be working right now. Sorry

--Felgerkarb 22:57, 17 June 2006 (UTC)

Treatment

Removed 'fewer risks' for coiling of cerebral aneurysms, as this isn't entirely accurate. Coiling has a set of different risks, and perhaps fewer minor complications. The stroke rate (major complication) is similar to clipping, though with a statistically insignificant trend to fewer complications. The complication rate is also dependent on age. Further, I assume you were talking about peri-procedural complications. The data, while promising, is still not conclusive that coiling has a lower long term complication/recurrence/rebleed rate than clipping. Basically, I didn't want someone reading this and thinking it is a 'slam dunk' that coiling is better than clipping.Felgerkarb 20:28, 26 October 2006 (UTC)

• I believe the User:Nus1937 made a common error in conflating the aneurysm recurrence rate with the aneurysm rebleed rate. The data clearly shows a higher recurrence rate with coiling, and the higher rate of aneurysm retreatment. What the data does not show, somewhat counterintuitively, is a difference in the rate of recurrent hemorrhage after coiling vs. clipping. I corrected the error, and, in fact, one of the citations he quoted makes this point (Campi et al 2007). I also formatted the citations.

I also removed the following as being POV:

'At present it appears that only older patients with aneurysms that are difficult to reach surgically are more likely to benefit from endovascular coiling.'

The data suggests that older patients do better with coiling than clipping, but that does not translate into younger patients doing worse with coiling vs. clipping. As the OP mentions, the complication rates are equivalent between the two procedures (with a trend towards lower major complications in coiling) --Felgerkarb 20:42, 6 August 2007 (UTC)

Prognosis

I'd like to request public opinion on whether it is accurately to say "Generally, about two thirds of patients have a poor outcome, death or permanent disability...". Lots of people with loved ones in critical condition read this, whethere it gives or takes hope from them. We need quotation!

• Done. The most recent article notes a general decline in mortality rates, but doesn't comment on any change in the proportion of patients who survive with severe disability. Unfortunately, aneurysmal subarachnoid hemorrhage is still a very bad thing. Felgerkarb 18:55, 7 May 2007 (UTC)