Rationale and Objectives
In this review we will discuss the historic development of intracranial aneurysms as a pathologic entity and the potential for overdiagnosis.
Materials and Methods
We conducted a literature search to assess the prevalence, rupture rate, and treatment of intracranial aneurysms.
Results
Intracranial aneurysms represent a necessary example of overdiagnosis.
Conclusions
A change in the nomenclature of small aneurysms is a possible solution to mitigate patient anxiety from a diagnosis of intracranial aneurysm.
Since the 18th century, intracranial aneurysms were recognized by physicians as a silent scourge, which could kill indiscriminately. In 1927, when Moniz introduced cerebral angiography to the world, the diagnostic and therapeutic outlook of intracranial aneurysms changed forever . As with any technologic innovation, the moment a new medical diagnostic tool arrives, a rush to prove its utility and effectiveness ensues. Expectedly, cerebral angiography quickly became an integral component in the workup and identification of cerebral aneurysms . The study of intracranial aneurysms continued to grow, and clinicians required epidemiologic data to better understand the prevalence of this phenomenon and to develop appropriate treatment algorithms. A 42-year autopsy series published in 1958 by Housepian and Pool described the prevalence of aneurysms as 2% in adults . Approximately, 71% of identified aneurysms produced a fatal hemorrhage, which they subdivided into initial and subsequent bleeding episodes . Notably, 6.6% of ruptured aneurysms measured 1–2 mm and 38.7% of ruptured aneurysms measured 3–5 mm . More recently, the mean prevalence of intracranial aneurysms varies, being quoted as high as 5%–10% by Caranci et al. . The discrepancy in prevalence over time is likely multifactorial, with more inclusive characterization, larger data sampling, and an increase in imaging volume serving as contributing factors.
One factor which did not contribute to this increased prevalence is size criteria. The autopsy series by Housepian and Poole classified intracranial aneurysms according to the following criteria: 1–2 mm, 3–5 mm, 6–10 mm, 11–20 mm, 21–40 mm, >40 mm . The presence of aneurysms was based on alterations in the histologic morphology of the vessel wall as identified on microscopic section . Additionally, histologic changes were present at vascular bifurcations in keeping with the expected evolution of histologic changes associated with the development of aneurysms .
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Epidemiology of cerebral aneurysm rupture
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Evaluation of methodology
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The components of uncertainty in a health care interaction
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Ethical issues surrounding testing and uncertainty
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Nomenclature
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Conclusions
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