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Unruptured Intracranial Aneurysms- Pathogenesis and Individualized Management
Nima Etminan1, Arnd Dörfler, Helmuth Steinmetz
1Department of Neurosurgery, UMC Mannheim, Medical Faculty, Ruprecht-Karls-Universität Heidelberg; Department of Neuroradiology, University Hospital Erlangen, University of Erlangen-Nuremberg; Department of Neurology, Center of Neurology and Neurosurgery, Universitätsklinikum Goethe- Universität Frankfurt.
Unruptured intracranial aneurysms (IAs) require individualized management. Growing aneurysms and risk factors like hypertension increase rupture risk, necessitating careful monitoring and treatment.
Area of Science:
- Neurology
- Neurosurgery
- Public Health
Background:
- Approximately 2 million adults in Germany have unruptured intracranial aneurysms (IAs).
- Rupture of an IA can cause a life-threatening subarachnoid hemorrhage.
- Decisions regarding the management of incidentally detected IAs are crucial.
Purpose of the Study:
- To review current data on unruptured intracranial aneurysms in Germany.
- To inform clinical decision-making for patients with unruptured IAs.
- To highlight the need for individualized risk assessment and management strategies.
Main Methods:
- Selective PubMed search for "unruptured intracranial aneurysms" (July 2019).
- Analysis of German Federal Statistical Office data (2005-2017) on cerebral aneurysm hospitalizations.
- Exclusion of subarachnoid hemorrhage diagnoses.
Main Results:
- Patient numbers for unruptured IAs in Germany increased 2.3-fold (2005-2017).
- Average 5-year rupture risk (3%) is comparable to treatment risks (approx. 4%).
- Risk factors (hypertension, smoking, alcohol, IA morphology) significantly influence rupture likelihood; growing aneurysms are 12x more likely to rupture.
Conclusions:
- Individualized assessment and management are essential for patients with unruptured IAs.
- Treatment of modifiable risk factors is important.
- A phase III clinical trial is investigating blood pressure reduction and aspirin for IA management.
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