[Unruptured cerebral aneurysms: Controversies on population screening]

Abstract

The idea of population screening of unruptured intracranial aneurysms is interesting because, despite recent advances in surgical and endovascular treatment, the mortality related to aneurismal subarachnoid haemorrhage reaches 30%. Screening is justified whenever the morbidity and mortality of the treatment (markedly lower for unruptured compared to ruptured aneurysms) overcomes the inherent risk of harbouring a brain aneurysm. Although, at present, this balance does not seem to favour population-based screening, it is justified in certain sub-populations with an increased risk of rupture. In this review, an analysis is made of the requirements for implementing a screening program, when would it be justified, what is to be expected from treatment (in terms of effectiveness, morbidity and costs), and what medical-legal issues are relevant and to determine the usefulness of the program. A study protocol is proposed aimed at examining the usefulness of population screening for brain aneurysms by magnetic resonance angiography.

Keywords: Aneurisma cerebral; Cerebral aneurysm; Clipado; Clipping; Coiling; Cribado; Embolización; Hemorragia subaracnoidea; Prognosis; Pronóstico; Screening; Subarachnoid haemorrhage.