Treatment of unruptured intracranial aneurysms: a review

Abstract

In this article, we discuss the important natural history studies of UIAs and discuss the existing scientific evidence and recent advances that help identify the rupture risk guide management of UIAs. We also address the recent advances in pharmacological therapy of UIAs. Expert commentary: In the recent years, there have been great advances in understanding the pathophysiology of UIAs and determining the rupture risk going beyond the traditional parameter of aneurysm size. Aneurysm morphology and hemodynamics play a pivotal role in growth and rupture. A true randomized trial for the management of UIAs is the need of the hour.

Role of Morphological and Hemodynamic Factors in Predicting Intracranial Aneurysm Rupture: A Review

“…In this review article, we reviewed 19 studies that collectively had 7269 patients and 9167 cases of IAs, of which 1701 had ruptured [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Fourteen studies were observational studies, three of them were review articles, one was a meta-analysis, and one was a case series.…”

“…Therefore, despite the guidelines, treatment should be individualized, and the expertise of the individual center should be taken into consideration. The risk of treatment at a center depends upon the cerebrovascular expertise of the neurosurgeons and neurointerventionists [15].…”

Preventing Rupture: Clipping of Unruptured Intracranial Aneurysms

“…This also applies to UIAs regarding what can cause them to bleed and when. There is a high variability between populations in the prevalence of UIAs, being cited between 1% and as much as 7% of the general population [39][40][41][42]. They are more commonly found in the anterior circulation, at more advanced ages, and more often in women.…”

“…Fortunately, small aneurysms of the cavernous segment generally present a low risk of rupture [73]. Therefore, taking into consideration the hemorrhage rates described by ISUIA for aneurysms of this location, it is generally not advisable to treat asymptomatic lesions smaller than 5 mm in any way [39,73]. Aneurysms larger than 7 mm or those that are symptomatic can be safely treated by either method with satisfactory postoperative results.…”

“…It has been repeatedly demonstrated that microsurgery leads to fewer such instances [75][76][77][78][79][80][81][82]. Although the issue of hemorrhage after initial treatment and its consequences have been extensively covered for ruptured aneurysms, there is currently no such data for UIAs [39]. Patients should therefore be regularly monitored (we recommend yearly CTA investigations), regardless of the form of treatment and any increase in size or change in morphology be contended judiciously.…”