Follow-up Results of Small, Asymptomatic, Unruptured Intracranial Aneurysms Detected by 3D-CTA and a Systematic Review of the Relevant Literature

Abstract

Objective: The management of increased detected unruptured intracranial aneurysms (UIAs) remains controversial because of conflicting results in different studies about the risk of UIA rupture and growth. This study aimed to evaluate the outcomes of UIAs. Methods: We followed up our UIAs detected by three-dimensional computed tomography angiography (3-D CTA) and also reviewed published studies. Results: Fifteen (18 UIAs) of 28 patients (31 UIAs) with UIAs detected by 3-D CTA were followed up 3 years after the UIAs were detected. There were no deaths or aneurysmal rupture, and almost all our follow-up UIAs remained constant in size. The Brief Symptom Rating Scale and Hamilton Depression Rating Scale were used to evaluate the psychological influence of UIAs and the improvements were significant after follow-up. Fifteen studies including 5205 patients with 7209 UIAs were reviewed to assess the risk of aneurysmal rupture, and the risk was significantly lower for aneurysms ＜10 mm, single aneurysms, anterior circulation location and male sex. To determine the risk of aneurysmal growth, we reviewed nine studies including 1248 patients with 1551 UIAs, and the risk was significantly lower for aneurysms ＜10 mm, single aneurysms and anterior circulation location. Conclusions: Small UIAs detected by 3D-CTA may be benign, can be left untreated and should be followed up 3 years after diagnosis.