MANAGEMENT OF SYMPTOMATIC AND ASYMPTOMATIC UNRUPTURED ANEURYSMS

Intradural unruptured saccular aneurysms are being diagnosed with incr easing frequency. Left untreated, these lesions usually progress, and the cumulative risk from bleeding usually outweighs the risk of treatm ent. Exceptions include patients with limited Life expectancy and pati ents over the age of 70 with small asymptomatic or giant posterior cir culation lesions associated with few symptoms. Therapeutic interventio n offers little over the natural history for these patients, and thera py should be considered only if symptoms progress or growth is documen ted. Treatment options should be coordinated by an experienced cerebro vascular surgeon with access to interventional adjuncts, EC-IC bypass, and circulatory arrest. GDC coiling should be reserved for non-surgic al cases, as the durability of this treatment is still being evaluated .