Preventive neurosurgery and medical ethics
D. Y. Usachev,
Sh. Sh. Eliava,
L. B. Likhterman,
S. B. Yakovlev,
A. D. Kravchuk,
V. A. Okhlopkov,
V. A. Lukshin,
A. N. Konovalov https://doi.org/10.63769/1683-3295-2025-27-4-123-134
Abstract
This paper explores the rapidly growing field of preventive neurosurgery, a promising area in modern clinical practice. With the help of advanced neuroimaging technologies, this approach is already widely used to treat cerebral aneurysms, arteriovenous malformations, and stenotic processes in major arteries supplying the brain, as well as in pediatric neuro-oncology. However, its application to tumors of the central nervous system in adults remains limited and less systematic. Drawing on the experience of the N. N. Burdenko National Medical Research Center for Neurosurgery, the paper examines key aspects of preventive neurosurgery, including ethical considerations, guidelines for decision-making, and criteria for when surgery is appropriate or not. A special focus is placed on the principle of «non nócere» (do no harm), particularly when dealing with individuals who are otherwise healthy. The authors highlight the urgent need to develop a robust framework for this field, encompassing its philosophy, methodology, and legal aspects, to address the unique challenges of preventive neurosurgery.
About the Authors
D. Y. Usachev
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
16 4th Tverskaya-Yamskaya St., Moscow 125047
Sh. Sh. Eliava
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
16 4th Tverskaya-Yamskaya St., Moscow 125047
L. B. Likhterman
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
Leonid Boleslavovich Likhterman
16 4th Tverskaya-Yamskaya St., Moscow 125047
S. B. Yakovlev
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
16 4th Tverskaya-Yamskaya St., Moscow 125047
A. D. Kravchuk
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
16 4th Tverskaya-Yamskaya St., Moscow 125047
V. A. Okhlopkov
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
16 4th Tverskaya-Yamskaya St., Moscow 125047
V. A. Lukshin
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
16 4th Tverskaya-Yamskaya St., Moscow 125047
A. N. Konovalov
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Россия
Россия
16 4th Tverskaya-Yamskaya St., Moscow 125047
References
1. Likhterman L., Long D., Likhterman B. Preventive neurosurgery: philosophy and practice. In: Likhterman L., Long D., Likhterman B. Clinical philosophy of neurosurgery. Moscow: GEOTAR-Media, 2015. Pp. 213–225. (In Russ.).
2. Moore W.S., Barnett H.J., Beebe H.G. et al. Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association. Circulation 1995;91(2):566–79. DOI: 10.1161/01.cir.91.2.566
3. International study of unruptured intracranial aneurysms. Unruptured intracranial aneurysms – risk of rupture and risks of surgical intervention. N Engl J Med 1998;339(24):1725–33. DOI: 10.1056/NEJM199812103392401
4. Onizuka М., Suyama K., Hiuza T. et al. Asymptomatic brain tumor detected at brain check-up. Neurol Med Chir (Tokyo) 2001;41(9):431–4; discussion 435. DOI: 10.2176/nmc.41.431
5. Raaymakers T.W., Rinkel G., Limburg M., Algra A. Mortality and morbility of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke 1998;29(8):1531–8. DOI: 10.1161/01.str.29.8.1531
6. Steiger H.-J. Preventive neurosurgery: population-wide check-up examinations and correction of asymptomatic pathologies of the nervous system. Acta Neurochir (Wien) 2006;148(10):1075–83. DOI: 10.1007/s00701-006-0882-6
7. Wiebers D.O., Whisnant J.P., Huston J. 3rd et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362(9378):103–10. DOI: 10.1016/s0140-6736(03)13860-3
8. Eliava Sh.Sh., Yakovlev S.B., Pilipenko Yu.V. et al. Unruptured asymptomatic aneurysms of cerebral arteries: modern approaches to the choice of surgical method and treatment outcomes. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2021;85(6):6–13. (In Russ., In Engl.). DOI: 10.17116/neiro2021850616
9. Eliava Sh.Sh., Yakovlev S.B., Pronin I.N. et al. Preventive surgical treatment of cerebral aneurysms. Ed. by Sh.Sh. Eliava. Moscow: Nauka, 2021. 312 p. (In Russ.).
10. Горожанин В.А., Дмитриев А.В., Коновалов А.Н. и др. Хирургическое лечение артериовенозных мальформаций головного мозга. Под ред. Ш.Ш. Элиава. М.: ИП Т.А. Алексеева, 2018. 229 с.
11. Gorozhanin V.A., Dmitriev A.V., Konovalov A.N. et al. Surgical treatment of cerebral arteriovenous malformations. Ed. by Sh.Sh. Eliava. Moscow: IP T.A. Alexeeva, 2018. 229 p. (In Russ.).
12. Cenzato M., Boccardi E., Beghi E. et al. European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH). Acta Neurochir (Wien) 2017;159(6):1059–64. DOI: 10.1007/s00701-017-3154-8
13. Wahood W., Alexander A.Y., Doherty R.J. et al. Elective intervention for unruptured cranial arteriovenous malformations in relation to ARUBA trial: a National Inpatient Sample study. Acta Neurochir (Wien) 2021;163(9):2489–95. DOI: 10.1007/s00701-021-04936-7
14. Etminan N., de Sousa D.A., Tiseo C. et al. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J 2022;7(3):V. DOI: 10.1177/23969873221099736
15. Chen C.J., Buell T.J., Ding D. et al. Consortium for Dural Arteriovenous Fistula Outcomes Research; CON DOR Collaborators. Intervention for unruptured high-grade intracranial dural arteriovenous fistulas: a multicenter study. J Neurosurg 2021;136(4):962–70. DOI: 10.3171/2021.1.JNS202799
16. Ostrom Q.T., Cioffi G., Waite K. et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2014–2018. Neuro Oncol 2021;23(12 Suppl 2): iii1–iii105. DOI: 10.1093/neuonc/noab200
17. Gorelyshev S., Jakovlev S., Adaev A. Vein of Galen Aneurysmal Malformations. In: Texbook of Pediatric Neurosurgery. Ed. by C. Di Rocco, D. Pang, J. Rutka. Springer, Cham, 2017. Pp. 1–46. DOI: 10.1007/978-3-319-31512-6_50-1
18. Matuev K.B. Brain tumors in infants. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2012;76(3):81–9. (In Russ.).
19. Usachev D.Yu., Lukshin V.A., Yakovlev S.B. Current issues in reconstructive surgery of major arteries of the head. Moscow: IP Rumyantsev Anton Alekseevich, 2020. 360 p. (In Russ.).
20. Usachev D.Yu., Lukshin V.A., Yakovlev S.B. et al. A 20-year experience in surgical treatment of steno-occlusive lesion of craniocervical arteries at the Burdenko Neurosurgical Center. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery. 2020;84(3):6–20. (In Russ., In Engl.). DOI: 10.17116/neiro2020840316
21. Den Hartog A.G., Achterberg S., Moll F.L. et al.; Smart Study Group. Asymptomatic carotid artery stenosis and the risk of ischemic stroke according to subtype in patients with clinical manifest arterial disease. Stroke 2013;44(4):1002–7. DOI: 10.1161/STRO KEAHA.111.669267
22. Paraskevas K.I., Nicolaides A.N., Kakkos S.K. Asymptomatic Carotid Stenosis and Risk of Stroke (Acsrs) Study: what have we learned from it? Ann Transl Med 2020;8(19):1271. DOI: 10.21037/atm.2020.02.156
23. Rijbroek A., Wisselink W., Vriens E.M. et al. Asymptomatic carotid artery stenosis: past, present and future. How to improve patient selection? Eur Neurol 2006;56(3):139–54. DOI: 10.1159/000096178
24. Akhmedov A.D., Usachev D.Yu., Lukshin V.A. et al. Carotid endarterectomy in patients with high surgical risk. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2013;77(4):36–42. (In Russ., In Engl.).
25. Usachev D.Yu., Lukshin V.A., Shulgina A.A. et al. Atherosclerotic stenoses and occlusions of major cerebral arteries. In: Neurosurgery. National Guidelines. Volume III. Vascular Neurosurgery. Ed. by D.Yu. Usachev, Sh.Sh. Eliava, S.B. Yakovlev, O.B. Belousova. Moscow: N.N. Burdenko National Medical Research Center for Neurosurgery, 2023. Pp. 474–517. (In Russ.).
26. Ogilvy C.S., Carter B.S. Stratification of outcome for surgically treated unruptured intracranial aneurysms. Neurosurgery 2003;52(1):82–8. DOI: 10.1097/00006123-200301000-00010
27. Moroi J., Hadeishi H., Suzuki A., Yasui N. Morbidity and mortality from surgical treatment of unruptured cerebral aneurysms at research institute for brain and blood vessels-akita. Neurosurgery 2005;56(2):224–31. DOI: 10.1227/01.neu.0000148897.28828.85
28. Kotowski M., Naggara O., Darsaut T.E. et al. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 2013;84(1):42–8. DOI: 10.1136/jnnp-2011-302068
29. Drexler R., Sauvigny T., Pantel T.F., Ricklefs F.L. Global outcomes for microsurgical clipping of unruptured intracranial aneurysms: a benchmark analysis of 2245 cases. Neurosurgery 2024;94(2):369–78. DOI: 10.1227/neu.0000000000002689
30. Shen Z., Zhao Y., Gu X. et al. Systematic review of treatment for unruptured intracranial aneurysms: clipping versus coiling. Turk Neurosurg 2024;34(3):377–87. DOI: 10.5137/1019-5149.JTN.23729-18.1
Review
For citations:
Usachev D.Y., Eliava Sh.Sh., Likhterman L.B., Yakovlev S.B., Kravchuk A.D., Okhlopkov V.A., Lukshin V.A., Konovalov A.N. Preventive neurosurgery and medical ethics. Russian journal of neurosurgery. 2025;27(4):123-134. (In Russ.) https://doi.org/10.63769/1683-3295-2025-27-4-123-134
Views:
25
JATS XML
Email this article 