Global Differences in the Present and Future Management of Cerebral Aneurysms

INTRODUCTION: The publication of the International Subarachnoid Aneurysm Trial and the International Study of Unruptured Intracranial Aneurysms rapidly changed the management of patients with subarachnoid hemorrhage in many countries. Future trends of aneurysm management will have significant implications for patients, health systems, and how we educate future cerebrovascular specialists internationally. METHODS: We describe past, present, and future trends in the management of patients with cerebral aneurysms. We recorded responses from 283 neurosurgeons and neuroradiologists in 46 countries. We explored similarities and differences in the availability and use of endovascular and open techniques of aneurysm treatment, imaging, and follow-up techniques, effectiveness and limitations of currently available techniques. RESULTS: More European respondents report that their hospitals perform coiling and fewer report that they perform stenting. The proportions of coiling to clipping vary greatly in all regions. Respondents predicted that flow-diversion treatment of aneurysms with the use of stenting will show large increases and that coiling will show a mild decrease in Europe and North America and an increase in the rest of the world. Respondents predicted that although clipping will remain essential, it will significantly decrease in use during the next 5 years all over the world. CONCLUSIONS: Significant differences exist in the management of cerebral aneurysms internationally, but the trends indicate that endovascular means of treating aneurysms will continue to increase in popularity globally. This report illustrates changes, which have significant economic and educational implications, that need to be addressed by organized neurosurgery in conjunction with industry partners.