Aneurysm observation versus intervention: a literature review

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating illness that affects persons at the peaks of their lives. The 1990s witnessed rapid growth in noninvasive vascular imaging technologies, which allowed safe diagnosis of unruptured saccular intracranial aneurysms. Presently, it is unclear who will benefit from screening. Mass screening is neither feasible nor cost-effective. The current literature suggests that persons in a family with two or more relatives with a history of SAH are most likely to benefit from screening. Individuals with a history of SAH, with aneurysms greater than 10 mm in diameter or with symptomatic aneurysms are clearly at increased risk for SAH. These aneurysms should be treated, though the method of treatment remains open to question. Treatment of older patients or those with smaller aneurysms has been modeled by decision analysis, but has yet to be verified in a prospective clinical trial. Future directions for aneurysm management are explored.