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Management of unruptured incidentally found intracranial saccular aneurysms

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Abstract

Unruptured intracranial saccular aneurysms occur in 3–5% of the general population. As the use of diagnostic medical imaging has steadily increased over the past few decades with the increased availability of computed tomography (CT) and magnetic resonance imaging (MRI), so has the detection of incidental aneurysms. The management of an unruptured intracranial saccular aneurysm is challenging for both patients and physicians, as the decision to intervene must weigh the risk of rupture and resultant subarachnoid hemorrhage against the risk inherent to the surgical or endovascular procedure. The purpose of this paper is to provide an overview of factors to be considered in the decision to offer treatment for unruptured intracranial aneurysms in adults. In addition, we review aneurysm and patient characteristics that favor surgical clipping over endovascular intervention and vice versa. Finally, the authors propose a novel, simple, and clinically relevant algorithm for observation versus intervention in unruptured intracranial aneurysms based on the PHASES scoring system.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. C. Rory Goodwin MD PhD was supported by grants from NIH/NINDS K12 NRCDP Physician Scientist Award (2K12NS080223-06) and Robert Wood Johnson Harold Amos Medical Faculty Development Program (RWJ 76238).

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Authors and Affiliations

  1. Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA

    Vikram A. Mehta, Charis A. Spears, Jihad Abdelgadir, Timothy Y. Wang, Eric W. Sankey, Andrew Griffin, C. Rory Goodwin & Ali Zomorodi

  2. Duke University School of Medicine, Durham, NC, USA

    Charis A. Spears

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  1. Vikram A. Mehta
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Mehta, V.A., Spears, C.A., Abdelgadir, J. et al. Management of unruptured incidentally found intracranial saccular aneurysms. Neurosurg Rev 44, 1933–1941 (2021). https://doi.org/10.1007/s10143-020-01407-y

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