Management strategy of unruptured intracranial aneurysms according to the natural course and problems to be solved

Abstract

Management strategy of the unruptured intracranial aneurysms（UIA）should be made by balancing rupture risk and management risk of aneurysms as well as patient’s physical and mental conditions. Rupture risks and its prediction models of UIA have been recently reported, but treatment risks needs to be further defined. In the meantime, unruptured intracranial aneurysms treatment score, which is a consensus decision tool whether individual aneurysms should be treated or conservatively managed, was also reported. These various tools can be used to support management decisions. However, each patient’s attitude, understanding of the natural history of aneurysms and treatment risks vary significantly, and, hence, risk communication method between patients and doctors needs to be improved. Other problems to be solved include：1）Poor natural course and higher mortality of patients with UIA not due to UIA rupture, 2）Further clarification of modifiable factors influencing development and rupture of the aneurysms and development of medical treatment of aneurysms, 3）Developing guidelines of management of UIA in elderly, which carries higher rupture risk and poorer prognosis when ruptures. In this article, these issues are discussed.