未破裂脳動脈瘤の治療選択 : Macro・microの視点からみたパラダイムシフト(<特集>未破裂脳動脈瘤の治療方針)  [in Japanese] Treatment of Unruptured Cerebral Aneurysm: Paradigm Shift Drawn from Macro- and Microscopic Viewpoint of the Rationale(<Topics> Management for Unruptured Cerebral Aneurysm)  [in Japanese]

The rationale for radical surgery to treat unruptured cerebral aneurysms (uAN) remains unclear. Most investigations of evidence-based medicine (EBM) have focused on prognostic factors such as the natural history, surgical outcome, risk-benefit analysis, and socioeconomic effects, and not on patient factors such as decision-making, anxiety, or satisfaction. However, the number of legal cases focusing on complications caused by examination or surgical intervention has increased in Japan. Further, deterioration of quality of life in patients diagnosed with uAN has also become eviclent. In this study, we surveyed patient, satisfaction (PS) in 197 patients who underwent clipping surgery or coil embolization during the last 7 years, using a mail questionnaire sent by a third party. We review the rationale for the treatment of uAN, and discuss the necessity of a paradigm shift of rationale from treatment based on EBM to treatment that is tailor-made.