title: Cerebral aneurysm treatment in India: Results of a national survey regarding practice patterns in India.
abstract: BACKGROUND
  The management of intracranial aneurysms (IAs) varies widely depending upon a number of factors.
  
  
  OBJECTIVE
  To understand the variations in practice patterns in the treatment of IAs in India.
  
  
  METHODS
  The survey consisted of 23 questions. Two group emails were sent to members of the Neurological Society of India and the Neurological Surgeons Society of India. Uni- and multivariate analysis was performed where appropriate.
  
  
  RESULTS
  The response rate was 10.13% (150/1480). Fifty percent of the respondents used steroids in subarachnoid hemorrhage and 64% initiated triple-H therapy prophylactically. There was no significant difference in the use of steroids, antifibrinolytics, mannitol, or hypertonic saline and the choice of therapeutic intervention (clipping or endovascular therapy [EVT]) for anterior circulation aneurysms between physicians working at teaching and nonteaching hospitals. However, physicians in teaching and government hospitals were less likely to choose EVT for middle cerebral artery aneurysms as the first line of treatment (odds ratio [OR] 0.6 and 0.1, respectively). Physicians working at private hospitals were more likely to have EVT facilities than those working in government-owned hospitals. On multivariate analysis, physicians working in teaching hospitals preferred surgical clipping to EVT for posterior circulation aneurysms (OR = 0.7) and physicians at teaching hospitals performed >50 cases/year.
  
  
  CONCLUSIONS
  Our study demonstrates the prevailing practice patterns in the management of IAs in India. Surgical clipping is the preferred treatment of choice for anterior circulation aneurysms and EVT for aneurysms along the posterior circulation. Corticosteroids and prophylactic "triple-H" therapy are still used by a large proportion of physicians.
authors.affiliation: Department of Neurological Surgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
authors.forename: Sudheer
authors.initials: S
authors.lastname: Ambekar
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Madhugiri
authors.forename: Paritosh
authors.initials: P
authors.lastname: Pandey
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
mesh_terms: D006801:Humans; D007194:India; D002532:Intracranial Aneurysm / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires