Abstract
To determine the surgical indication of supratentorial asymptomatic unruptured cerebral aneurysms (SAUCAs), we investigated the literature regarding the natural history of and surgical result for SAUCAs. We obtained the following results: 1) The annual rupture rate of SAUCAs is estimated at approximately 1 to 2%, except for a very low rupture rate suggested by International Cooperative Study because it seemed to be highly biased regarding patient selection ; 2) Small aneurysms (<5mm) and aneurysms harbored in elderly patients over 70 years of age have a chance of rupture ; 3) Surgical mortality and morbidity is 1% and 4%, respectively, and ; 4) In the present situation, direct surgery should be considered as the primary option of treatment. Based on the above mentioned reasons, surgical indication of SAUCAs is valid on persons who can manage ordinary daily life without severe systemic disease even if they are over 70 years of age, and who present with nongiant aneurysm including small aneurysms (<5mm). On the other hand, in cases of giant aneurysm, the age of the patient should be less than 70.
