[Unruptured Intracranial Aneurysm: Possible Therapeutic Strategies?]— Proust 2005

The issue of an intracranial unruptured aneurysm (ICUA) is now frequently brought up in patient consultations. According to estimates, death rates after fissuration range from 52 to 85.7%. The ultimate therapeutic choice is made after weighing the risks of rupture and those associated with aneurysmal exclusion. The classification of risk factors is made possible by the analysis of rupture risk. For incidental ICUA bigger than 7 mm and in the event of concomitant aneurysms, we regarded the ICUA to be at high risk of rupture depending on the circumstances of diagnosis. According to morphologic characteristics, high-risk ICUA were found in the vertebrobasilar system (RR: 4.4; 95%CI: 2.7-6.8), between 7 and 12 mm in size (RR: 3.3; 95%CI: 1.3-8.2), and larger than 12 mm (RR: 17; 95%CI: 8-36.1), as well as those that were larger or multilobular or had an index P/L higher than 3.4. (risk x20). ICUA in the family poses a serious danger of rupture (2 to 7 times sporadic ICUA). ICUA rupture was associated with some systemic variables, including smoking addiction and arterial hypertension (RR: 3.04; 95%CI: 1.21-7.66). The morbidity and mortality rates were 10% and 2%, respectively, following microsurgical exclusion. Age (32%>65 years), size (14%>15 mm), vertebrobasilar placement, and temporary occlusion are a few of the microsurgical morbidity variables that have been discovered. After microsurgical exclusion, the rupture incidence was predicted to be 0.26 percent each year. The morbidity and death rates were 8% and 1%, respectively, following endovascular exclusion. The percentage of total exclusion ranged from 47% to 67%. The rupture risk was calculated to be 0.9% year. Treatment suggestions were divided into three groups.

Proust, F., Derrey, S., Debono, B., Gérardin, E., Dujardin, A. C., Berstein, D., Douvrin, F., Langlois, O., Verdure, L., Clavier, E., & Fréger, P. (2005). Anévrismes intracrâniens non rompus: que proposer? [Unruptured intracranial aneurysm: possible therapeutic strategies?]. Neuro-Chirurgie, 51(5), 435–454. https://doi.org/10.1016/s0028-3770(05)83502-7