Mathematical Analysis of the Effectiveness of Screening for Intracranial Aneurysms in First-Degree Relatives of Persons with Subarachnoid Hemorrhage

• Published in: World neurosurgery 2023-07, Vol.175, p.e542-e573
• Main Authors: Konovalov, Anton, Grebenev, Fyodor, Savinkov, Rostislav, Grebennikov, Dmitry, Zheltkova, Valeria, Bocharov, Gennady, Telyshev, Dmitry, Eliava, Shalva
• Format: Article
• Language: English
• Subjects: Cerebral aneurysm; Cost-effectiveness; Disability; Humans; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - genetics; Intracranial Aneurysm - surgery; Magnetic Resonance Angiography; Mass Screening - adverse effects; Preventive treatment; Risk Factors; Screening; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - genetics; Subarachnoid Hemorrhage - surgery
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.03.138

Population screening for aneurysms in patients with risk factors and preventive surgical treatment are beneficial according to numerous studies. One of the most significant risk factors is heredity, namely, the presence of first-degree relatives (FDR) with aneurysmal subarachnoid hemorrhage (aSAH). Nevertheless, there are still no generally accepted approaches or evidence bases regarding the benefits of the aneurysm screening strategy. Mathematical modeling of the dynamics of aneurysm development in the population was carried out using an algorithm implementing a discrete Markov's chain. To implement the model, all probabilities of events and distributions are taken from available literature sources. Three-dimensional time of flight noncontrast magnetic resonance angiography was chosen as a screening method. Patients underwent preventive surgical treatment if an aneurysm was detected. Screening and preventive treatment in the general population reduces the prevalence of aneurysms by 1.74% (3.44% in the FDR group) and the prevalence of aSAH by 14.36% (37.48% in the FDR group). Mortality due to aSAH was reduced by 14.44%. The number of disabilities also decreases. The occurrence of deep disability was reduced by 20.2% in the FDR group. Economic analysis of the part of the population consisting of FDRs showed annual savings of ies also decr The mathematical model demonstrated that screening and preventive treatment of cerebral aneurysms can reduce aSAH-associated morbidity and mortality. In the FDR group, there was decrease in the prevalence of aSAH and decrease in associated mortality. Screening for cerebral aneurysms is cost-effective.