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)

Not sure why, but the rebleed/recurrence problem got back in, this time citing an editorial page in a neurosurgery journal. The data as of 2010 still shows no significant difference in rebleed rates between coiled and clipped aneurysms after 30 days. Also, the treatment section failed to mention the persistently lower mortality rate (7%) in subarachnoid patients treated with coiling versus clipping.

I think if it keeps coming back in, we might have to consider an NPOV flag, as it isn't supported by the data. No one would dispute a higher recurrence rate, and some might logically think that this means a higher re-bleed rate, but it just shows how little we understand about the physiology of aneurysms and aneurysm rupture when we see that the data does not show such a relationship.

Felgerkarb (talk) 17:32, 18 March 2010 (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)

Rated the Page

I added a ranking to the page. I rated it as a Start Class on the quality scale. Its a start due to it uses many large words that wouldn't be understandable to the general public. I also rated it as a Mid Importance article on the Importance scale. Aaron5367 01:56, 30 October 2007 (UTC)

External links

Wikipedia's external links policy and the specific guidelines for medicine-related articles do not permit the inclusion of external links to non-encyclopedic material, particularly including internet chat boards and e-mail discussion groups. Because I realize that most normal editors haven't spent much time with these policies, please let me provide specific information from the guidelines:

• This page, which applies to all articles in the entire encyclopedia, says that links "to social networking sites (such as MySpace or Fan sites), discussion forums/groups (such as Yahoo! Groups), USENET newsgroups or e-mail lists" are to be avoided.

• This page deprecates ""helpful" external links, such as forums, self-help groups and local charities."

• This medical-specific page reinforces the pan-Wiki rules, with a note that "All links must meet Wikipedia's external links guidelines, which in particular exclude discussion forums."

Wikipedia is an encyclopedia, and while it may occasionally be useful to patients or their families, it is not a web directory for patient services. Please do not re-insert links that do not conform to the standard rules. Any editor, BTW, is welcome to read all of the rules and perform an "audit" in the remaining links. Thanks, WhatamIdoing (talk) 03:14, 28 April 2008 (UTC)

Grading

Citations would be very helpful here. Is the survivability of "Instant Death" (Grade 6) really 4%? —Preceding unsigned comment added by 142.177.56.164 (talk) 02:27, 26 February 2009 (UTC)

Benefits and Risks

Has anyone else noticed the odd little comments in parenthesis in the benefits and risks section? 128.192.51.127 (talk) 18:05, 24 February 2010 (UTC)