Management of Small Unruptured Intracranial Aneurysms

This article reviews current scientific understanding and clinical management practices for small unruptured intracranial aneurysms (sUIAs). The management of sUIAs has been a longstanding controversial issue due to the lack of consensus on whether these aneurysms require treatment. Traditionally, these aneurysms have been conservatively managed and monitored. However, as understanding of aneurysm natural history has grown and treatment methods have improved, the field of sUIA management has shifted toward microsurgical and endovascular approaches. Therefore, it is important for neurosurgeons to have an updated review of current management practices of sUIAs to improve their care for this patient population. From this activity, neurosurgeons will gain a comprehensive understanding of sUIA management by reviewing risk factors for sUIA growth and rupture, screening recommendations, decision-making heuristics, and updated treatment methods. Key takeaways from this activity include: (1) appreciating the unique features of sUIAs, which make these lesions controversial to manage; (2) identifying specific risk factors for sUIA growth and rupture; (3) understanding screening guidelines and treatment methods for these aneurysms; and (4) acknowledging remaining gaps in knowledge of sUIA decision-making and management.