PHASES and the natural history of unruptured aneurysms: science or pseudoscience?
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests


  • Responses are moderated before posting and publication is at the absolute discretion of BMJ, however they are not peer-reviewed
  • Once published, you will not have the right to remove or edit your response. Removal or editing of responses is at BMJ's absolute discretion
  • If patients could recognise themselves, or anyone else could recognise a patient from your description, please obtain the patient's written consent to publication and send them to the editorial office before submitting your response [Patient consent forms]
  • By submitting this response you are agreeing to our full [Response terms and requirements]

Vertical Tabs

Other responses

Jump to comment:

  • Philip G. R. Schmalz, Mark R. Harrigan and Paul M. Foreman
    Published on:
  • Published on:
    Letter to the Editor
    • Philip G. R. Schmalz, Neurosurgery resident University of Alabama at Birmingham
    • Other Contributors:
      • Mark R. Harrigan, Professor of Neurosurgery
      • Paul M. Foreman, Neurosurgery resident

    We read with interest the editorial by Darsaut and colleagues entitled, “PHASES and the natural history of unruptured aneurysms: science or pseudoscience?”[1]. Beginning with references to Aristotle and Pliny the Elder (always impressive), the authors launch a critique of studies of the natural history of unruptured aneurysms. With attention to ISUIA and the PHASES system, the contributors from Quebec call attention to limitations in both prospective and retrospective studies of the risk of rupture and associated risk factors for rupture of intracranial aneurysms. In their view, these imperfect studies are so deeply flawed that they are essentially useless as tools to inform decision-making with patients with unruptured intracranial aneurysms. Ending with the umpteenth call for a randomized trial, the authors create the impression that, for all patients with all kinds, sizes and locations of intracranial aneurysms, clinicians are powerless to use data from the available studies, condensed in the PHASES Score, to guide decision-making.

    The PHASES score, developed from a pooled analysis of six prospective cohort studies of patients with unruptured intracranial aneurysms, was designed to use existing natural history data (limited though that may be), to provide some estimate of future rupture risk and to aid in identifying risk factors for rupture that may push clinician and patient past the treatment threshold. Several lines of evidence support the use of PHASES...

    Show More
    Conflict of Interest:
    None declared.