Management of unruptured incidentally found intracranial saccular aneurysms
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REVIEW
Management of unruptured incidentally found intracranial saccular aneurysms Vikram A. Mehta 1 & Charis A. Spears 1,2 & Jihad Abdelgadir 1 & Timothy Y. Wang 1 & Eric W. Sankey 1 Andrew Griffin 1 & C. Rory Goodwin 1 & Ali Zomorodi 1
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Received: 26 May 2020 / Revised: 22 September 2020 / Accepted: 29 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Unruptured intracranial saccular aneurysms occur in 3–5% of the general population. As the use of diagnostic medical imaging has steadily increased over the past few decades with the increased availability of computed tomography (CT) and magnetic resonance imaging (MRI), so has the detection of incidental aneurysms. The management of an unruptured intracranial saccular aneurysm is challenging for both patients and physicians, as the decision to intervene must weigh the risk of rupture and resultant subarachnoid hemorrhage against the risk inherent to the surgical or endovascular procedure. The purpose of this paper is to provide an overview of factors to be considered in the decision to offer treatment for unruptured intracranial aneurysms in adults. In addition, we review aneurysm and patient characteristics that favor surgical clipping over endovascular intervention and vice versa. Finally, the authors propose a novel, simple, and clinically relevant algorithm for observation versus intervention in unruptured intracranial aneurysms based on the PHASES scoring system. Keywords Intracranial aneurysms . Incidental intracranial aneurysms . Unruptured intracranial aneurysms . Open vascular . Endovascular intervention
Introduction Intracranial aneurysms were first reported in the literature in 1761 when Morgagni of Padua described a case of an unruptured carotid aneurysm. [1] Our understanding of intracerebral aneurysms has advanced tremendously since that time, especially with the introduction and advancement of endovascular techniques. While intracranial saccular aneurysms may present with neurological deficits or other symptoms, an estimated 59% of unruptured aneurysms are asymptomatic. [2] However, with increased utilization of noninvasive imaging, patients are increasingly likely to have an aneurysm be incidentally discovered. The management of unruptured incidental intracranial saccular aneurysms is challenging for both patients and physicians, as
the decision to intervene involves balancing the risks of rupture and subarachnoid hemorrhage against the periprocedural risks inherent to surgical or endovascular intervention. Other factors, including the patient’s potential anxiety regarding living with an unruptured aneurysm, play an unquantifiable role in decisionmaking. [3] This paper aims to provide an overview of select factors to be considered in the decision to offer intervention for this challenging pathology and to propose a simple treatment algorithm for observation versus intervention. As aneurysmal morphology can be infinitely complex, with various treatment options and protocols for each type, herein, the authors w
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