Intravascular treatment has recently been introduced in the treatment of asymptomatic unruptured cerebral aneurysms (AUCAs). On the other hand, ploblems of how to treat AUCAs have been left unresolved. Our management of AUCAs is as follows: the first choice is surgery, the second is intravascular treatment and the third is conservative treatment. Our indications of surgery for AUCAs are as follows: 1) age: under 75, 2) location: anterior circulation, and 3) size: over approximately 5 mm in diameter. Clinical features of patients with AUCAs were investigated. Between 1995 and 1998, we experienced 148 patients who harbored 193 AUCAs. The aneurysms with other diseases of central nervous systems, multiple aneurysms co-incidentally found with ruptured ones, carotid cavernous aneurysm and non-succular type of aneurysms were excluded. Fifty-one were male, and 97 were female. Ages ranged from 39 to 87 years (mean: 59 years). Surgery was done in 77 cases (52%), intravascular treatment in 43 (22%) and conservative treatment in 39 (26%). Therapeutic results of surgery were 3% permanent morbidity and no mortality. Intravascular treatment resulted in no permanent morbidity and no mortality. Long-term follow-up revealed no aneurysmal rupture in the intravascular treatment group. In the conservative treatment group, aneurysmal rupture was found in 3 cases (annual rupture rate was 3.1%). Those aneurysms were clipped successfully, but 1 patient died of acute heart failure 1 year later. Our management strategy provides satisfactory therapeutic results in patients with AUCAs. It is important to select the best treatment among the three treatments for AUCAs: surgery, intravascular treatment and conservative treatment.
