Guidelines for the surgical treatment of unruptured intracranial aneurysms: The first annual J. Lawrence pool memorial research symposium - Controversies in the management of cerebral aneurysms

Ricardo J. Komotar, J. Mocco, Robert A. Solomon

Research output: Contribution to journalArticle

122 Scopus citations

Abstract

THE MANAGEMENT OF unruptured cerebral aneurysms remains one of the most controversial topics in neurosurgery. To this end, we discuss the diagnosis and estimated prevalence of these lesions as well as review the literature regarding the rate of rupture for cerebral aneurysms and risks of operative intervention. Our interpretation of the literature concludes that aneurysms are present in approximately 1% of the adult population, varying between less than 1% in young adults to 4% in the elderly. The yearly risk of subarachnoid hemorrhage for an unruptured intracranial aneurysm is approximately 1% for lesions 7 to 10 mm in diameter. Based on these assumptions, we recommend that 1) with rare exceptions, all symptomatic unruptured aneurysms should be treated; 2) small, incidental aneurysms less than 5 mm in diameter should be managed conservatively in virtually all cases; 3) aneurysms larger than 5 mm in patients younger than 60 years of age should be seriously considered for treatment; 4) large, incidental aneurysms larger than 10 mm should be treated in nearly all patients younger than 70 years of age; and 5) microsurgical clipping rather than endovascular coiling should be the first treatment choice in low-risk cases. Critical to our guidelines is collaboration by a highly experienced cerebrovascular team of microneurosurgeons and endovascular neurosurgeons working at a tertiary medical center with a high case volume and using a decision-making paradigm designed to offer only low-risk treatments. In certain patients for whom both treatment and natural history carry high risks, such as those with giant aneurysms, nonoperative management is typically elected.

Original languageEnglish (US)
Pages (from-to)183-193
Number of pages11
JournalNeurosurgery
Volume62
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Keywords

  • Cerebral aneurysms
  • Endovascular coiling
  • International Study of Unruptured Intracranial Aneurysms
  • Subarachnoid hemorrhage
  • Surgical clipping

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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