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Unruptured intracranial aneurysms: benign curiosity or ticking bomb?

Lookup NU author(s): Patrick Mitchell, Dr Anil Gholkar OBE, Emeritus Professor David Mendelow


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15 years ago, the treatment of incidentally discovered intracranial aneurysms was straightforward with a good evidence base behind it. When intracranial aneurysms were identified, people were referred to neurosurgeons who would offer surgical repair if the patient was in reasonable health and had a good life expectancy. Since that time, several studies have given contradictory evidence for what should be done with these lesions, and a new technique for the repair of aneurysms, endovascular coil embolisation, has been developed. Here we review the research and make several recommendations. First, incidentally discovered aneurysms in the anterior circulation less than 7 mm in size in people with no personal or family history of subarachnoid haemorrhage should be left untreated. Second, people with remaining life expectancy of less than 20 years or so (le, those over age 60 years) should be informed that from a statistical point of view the benefits of treatment do not outweigh the risks. Third, in all other cases treatment with surgical clipping or coil embolisation should be advised. And finally, if surgical treatment is not feasible then medical hypotensive treatment may be a viable alternative.

Publication metadata

Author(s): Mitchell P, Gholkar A, Vindlacheruvu RR, Mendelow AD

Publication type: Review

Publication status: Published

Journal: The Lancet Neurology

Year: 2004

Volume: 3

Issue: 2

Pages: 85-92

ISSN (print): 1474-4422

ISSN (electronic): 1474-4465


DOI: 10.1016/S1474-4422(03)00661-6