2011 Volume 20 Issue 7 Pages 491-498
Considering treatment modality, timing and surgeons for the obliteration of unruptured cerebral aneurysms (UCA), there seems to be a wide variety of treatment options available in modern neurosurgery. UCA themselves are not a single pathological entity, but rather they are complex vascular lesions that range from small, incidentally found asymptomatic aneurysms to giant thrombosed lesions presenting life threatening brainstem compression. Treatment strategies for UCA should be determined depending on individual pathological factors such as aneurismal characteristics and patient background and their philosophy for life harbouring UCA. In this article, the authors focused on the surgical treatment for small asymptomatic UCA and discussed their current status and future perspective. Especially for incidentally found small asymptomatic UCA not suitable for interventional treatment, current state-of-the-art surgical techniques and supporting devices such as intraoperative monitoring and imaging can obtain almost zero operative mortality and only a few percent of morbidity. Prophylactic surgical obliteration of small, asymptomatic UCA should be justified only under the very small risk of perioperative adverse events. Clinical priorities avoiding any complication rather than tight neck clipping seem to be widely accepted.
