Natural History and General Management of Unruptured
After an aneurysmal subarachnoid hemorrhage, nearly half of the patients die and the half who survive suffer from irreversible cerebral damage. With increasing use of noninvasive neuroimaging techniques (for example, magnetic resonance and computerized tomography angiography), more unruptured cerebral aneurysms are found. To understand the prevalence of unruptured aneurysms in the general population, along with the risks of aneurysm formation, data on growth and rupture rates are crucial. The risk of rupture in aneurysms smaller than 10 mm is still not quite clear without a population-based prospective study. Nevertheless, a 0.5 to 2% annual risk may be a reasonable estimate. Growing aneurysms and those larger than 10 mm carry a higher rate of rupture. The management of an unruptured intracranial aneurysm should be based on a thorough understanding of the natural history of these lesions and careful evaluation of the morbidity and mortality levels associated with each treatment option.

Subarachnoid hemorrhage caused by rupture of an intracranial aneurysm carries a 30-day mortality rate of 45%, with approximately half the survivors sustaining irreversible brain damage. As a result of the increasing use of and improvements in noninvasive brain imaging modalities such as CT scanning, CT angiography, MR imaging, and MR angiography, a growing number of unruptured and often asymptomatic intracranial aneurysms are being diagnosed. The management of unruptured intracranial aneurysms remains controversial because of still incomplete and often conflicting data about the natural history of these lesions and the risks associated with their repair. Of the various types of lesions (saccular [or berry], fusiform [or dissecting], and inflammatory [mycotic] aneurysms), this article will be focused on the most common entity, unruptured intracranial saccular aneurysms.