Intracranial aneurysms: current evidence and clinical practice

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Unruptured intracranial aneurysms affect up to 6% of the population, often asymptomatically.
• Risk factors include family history, inherited disorders, age >50, female gender, smoking, and cocaine use.
• Surgical intervention carries significant morbidity and mortality, making screening controversial.

Purpose of the Study:

• To evaluate the controversial topic of screening for unruptured intracranial aneurysms.
• To identify patient groups who may benefit from early aneurysm detection.

Main Methods:

• Magnetic resonance angiography (MRA) is recommended for specific patient groups.
• Neurosurgical referral is indicated if an aneurysm is detected via MRA.

Main Results:

• Early detection via MRA and neurosurgical referral is beneficial for patients with autosomal dominant polycystic kidney disease.
• Early detection is also beneficial for patients with a history of aneurysmal subarachnoid hemorrhage.
• Screening is controversial for individuals with a family history of aneurysms, particularly those with two or more affected relatives.

Conclusions:

• Selective screening for unruptured intracranial aneurysms is warranted in specific high-risk populations.
• Routine screening for individuals with one first-degree relative with an aneurysm is not supported by current evidence.