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The indications for radical surgery to treat unruptured cerebral aneurysms (uAN) remain unclear. Most investigations of evidence-based medicine 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. This study undertook a survey of these factors in 172 patients who underwent radical surgery during the last 7 years, using a mail questionnaire sent to a third person. The total response rate was 53.5%. Almost 90% of patients could understand the explanation of their condition including the presence of uAN and risk of bleeding, and the proposed treatment. About 70 percent of patients (70.9%) selected the type of treatment from among observation, clipping, or coiling, and 72.8% decided on the same day as the explanation. Patient decision-making was affected by anxiety about bleeding (49.3%) and recommendation by the attending physician (43.2%). The delay from the decision to the operation was 1 month or less in half of the patients, but more than 6 months in about 20%. Sixty-nine patients with asymptomatic aneurysms found on brain examination were treated by clipping, and 10 with asymptomatic aneurysms by coil embolization. Eighty-one patients with aneurysms causing SAH or neurological symptoms were treated by clipping, and 12 with giant aneurysms underwent other surgery. Visual analogue scale analysis found that 75% of all patients were satisfied, but 91.6% of patients who underwent coil embolization were highly satisfied. The most common factor causing dissatisfaction was anxiety during the delay from the explanation to the surgical treatment (44%). Almost

Tailor-made Strategy for Treating Patients with Unruptured Cerebral Aneurysm.