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Treating the Unruptured Aneurysm: Guidelines from the Experts

Dr. Robert Solomon, author of new guidelines on the unruptured aneurysm
Dr. Robert Solomon
Dr. Connolly, author of recent guidelines on the unruptured aneurysm
Dr. E. Sander Connolly, Jr.

Imagine facing a tough problem. Wouldn’t it be great if you could get the input and agreement of dozens of different experts? Neurosurgeons think so.

That’s why Department Chair Dr. Robert Solomon and Vice Chair Dr. E. Sander Connolly participated in a recent consensus project on the subject of brain aneurysms.

Dr. Solomon and Dr. Connolly joined a group of 69 specialists from North America, Europe, Asia, Australia and New Zealand. They created a way that doctors anywhere can see how a large group of experts would recommend treating a particular case of unruptured brain aneurysm.

An unruptured aneurysm is a bulging, weak area in a blood vessel. If a brain aneurysm ruptures, blood can escape into the brain. This can be dangerous–even fatal. Only a tiny percentage of aneurysms will ever rupture. But it can be tough to determine which. This presents neurosurgeons and their patients with a quandary.

With more frequent brain imaging these days, aneurysms are detected more and more often. Most of these will never present a problem. Aneurysms at low risk for rupture can be treated by “conservative management.” That means monitoring the aneurysm, using medications when appropriate, and counseling the patient to change lifestyle factors like cigarette smoking or alcohol use.

In other cases, surgical repair of the aneurysm is called for. Depending on the situation, aneurysm repair can be done with traditional techniques or with minimally invasive techniques. Either way, it always carries a certain amount of risk. Neurosurgeons must weigh the risks and benefits of conservative management and surgical repair. This is a complicated process, and until now, there have not been clear-cut, easy-to-use guidelines to help compare the risks and benefits of each option.

But now, Dr. Solomon, Dr. Connolly, and dozens of other experts have helped develop an explicit and concise set of guidelines. To use the guidelines, doctors rank a number of criteria: a patient’s risk factors; the aneurysm’s size, shape, and location; whether the aneurysm is changing; and more.

In the end, doctors have a comparison of the two options (conservative management and surgical repair). This comparison will not replace the doctor’s and patient’s own decision-making, but it will provide a consensus opinion from the world’s foremost experts.

The journal Neurology published the paper online August 14, 2015. The article is forthcoming in their print edition. You can read the abstract on PubMed here, or the full text of the article on Neurology’s site here.

Dr. Connolly and colleague Dr. Philip Meyers also worked on an in-depth set of guidelines for management of the unruptured aneurysm. This work included a thorough review of more than 300 articles on the subject, and was published in August 2015 journal Stroke. Read our post about their work on that project here.

Learn more about Dr. Robert Solomon on his bio page here.

Learn more about Dr. E. Sander Connolly on his bio page here.

Learn more about Dr. Philip Meyers on his bio page here.

patient journey

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