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CEREBRAL ANEURYSMS

Screening

Because the incidence of cerebral aneurysms is about 5-15 million Americans, with a rupture rate of about 15,000-27,000 a year,⁶,¹⁹ aneurysms do not enjoy the “celebrity status” of heart disease, breast cancer or stroke.  These numbers are not trivial however, nor are the risks of serious neurological impairment and/or death which aneurysms represent. 

With the advent of non-invasive diagnostic imaging coupled with minimally invasive treatment options, the subject of cerebral aneurysm screening has come up in recent years.  Indeed, according to a 1999 paper by Yashimoto et al¹¹, aneurysm screening of the general population has become widespread in Japan.  However, the paper concluded that such widespread screening is not cost effective.  In a paper found on the LSU Department of Neurosurgery website ⁶, LSU professor of neurosurgery Dr. Deepak Awasthi MD, concluded “The incidence of SAH in the general population is relatively low (10 per 100,000 individuals)(¹³,²²) and MR angiography is relatively expensive (about $500-$1000 per study). Thus, cerebral aneurysm screening should be targeted to specific subpopulations at increased risk of aneurysm rupture and/ or formation. The risks of craniotomy or endovascular procedures and the poorly defined natural history of aneurysm formation, however, require the development of carefully planned strategies before large-scale proactive searches for cerebral aneurysms are undertaken”⁶.  In another paper from 2000, Wardlaw et al¹³ state that “…there may be a limited role for investigation of high risk subgroups. Ideally, screening in such subgroups should be tested in a randomized trial.”

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