Unruptured intracranial saccular aneurysms occur in 3–5% of the general population. As the use of diagnostic medical imaging has steadily increased over the past few decades with the increased availability of computed tomography (CT) and magnetic resonance imaging (MRI), so has the detection of incidental aneurysms. The management of an unruptured intracranial saccular aneurysm is challenging for both patients and physicians, as the decision to intervene must weigh the risk of rupture and resultant subarachnoid hemorrhage against the risk inherent to the surgical or endovascular procedure. The purpose of this paper is to provide an overview of factors to be considered in the decision to offer treatment for unruptured intracranial aneurysms in adults. In addition, we review aneurysm and patient characteristics that favor surgical clipping over endovascular intervention and vice versa. Finally, the authors propose a novel, simple, and clinically relevant algorithm for observation versus intervention in unruptured intracranial aneurysms based on the PHASES scoring system.

未破裂的颅内囊状动脉瘤发生在 3-5% 的普通人群中。随着计算机断层扫描 (CT) 和磁共振成像 (MRI) 的可用性的增加，诊断医学成像的使用在过去几十年中稳步增加，因此对偶发性动脉瘤的检测也在增加。未破裂颅内囊状动脉瘤的管理对患者和医生来说都是具有挑战性的，因为干预的决定必须权衡破裂和由此产生的蛛网膜下腔出血的风险与手术或血管内手术固有的风险。本文的目的是概述在决定为成人未破裂颅内动脉瘤提供治疗时要考虑的因素。此外，我们回顾了有利于手术夹闭而不是血管内介入的动脉瘤和患者特征，反之亦然。最后，作者提出了一种新颖、简单且临床相关的算法，用于基于 PHASES 评分系统对未破裂颅内动脉瘤进行观察与干预。