Management of symptomatic and asymptomatic unruptured aneurysms

Intradural unruptured saccular aneurysms are being diagnosed with increasing frequency. Left untreated, these lesions usually progress, and the cumulative risk from bleeding usually outweighs the risk of treatment. Exceptions include patients with limited life expectancy and patients over the age of 70 with small asymptomatic or giant posterior circulation lesions associated with few symptoms. Therapeutic intervention offers little over the natural history for these patients, and therapy should be considered only if symptoms progress or growth is documented. Treatment options should be coordinated by an experienced cerebrovascular surgeon with access to interventional adjuncts; EC-IC bypass, and circulatory arrest. GDC coiling should be reserved for non-surgical cases, as the durability of this treatment is still being evaluated.