The Delphi Oracle and the management of aneurysms

The history of human opinion is scarcely anything more than the history of human error. Voltaire1

The knowledge vacuum surrounding the management of unruptured intracranial aneurysms (UIAs) persists. It is acknowledged that good quality (randomized) data on which to base clinical decisions do not exist. However, this has not stopped the manufacture of non-evidence-based devices used to justify approaches where clinical decisions are made. The most recently published offering is the 'Unruptured Intracranial Aneurysm Treatment Score (UIATS)', generated via consensus sessions with world-renowned leaders.2 Notably, this iterative process is termed a 'Delphi' consensus, which should readily differentiate it from conventional scientific endeavors.

The UIATS is a complex score that combines patient-related, aneurysm-related, and treatment-related factors, and attributes 0–5 points per item, resulting in two columns of numerical values—one favoring aneurysm repair and the other favoring conservative management. A divergence in score of ≥3 between...

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