✓ PATIENT EDUCATION

Unruptured Intracranial Aneurysm

Q: What should I ask at my next visit?

Suggested questions include: your estimated rupture risk, whether observation or treatment is recommended and why, how often follow-up imaging is needed, whether work or exercise restrictions apply, and whether screening for additional aneurysms is appropriate.

Unruptured aneurysms are small dilations in arteries of the brain, most often detected incidentally on imaging studies. In the majority of patients, they cause no symptoms and will never rupture. Accurate evaluation, structured surveillance, and individualized treatment decisions are the foundation of safe and balanced management.

Incidental finding in ~90% of cases ~2% of the general population Usually asymptomatic Individualized treatment decision

You have been diagnosed with an unruptured intracranial aneurysm – what does this mean?

This diagnosis means that a small dilation has been identified in a blood vessel of the brain that has not ruptured. In most cases, it is discovered incidentally during imaging performed for unrelated reasons.

It is not a “time bomb waiting to explode,” but rather a condition that requires calm, expert assessment: what is the true risk of rupture, and which strategy (observation or intervention) is safest for you.

What is an unruptured intracranial aneurysm?

It is a localized dilation of the wall of a cerebral artery. Most aneurysms develop at arterial bifurcations, where hemodynamic forces are greatest. Many remain stable for years without ever causing clinical problems.

The vast majority of unruptured aneurysms will never rupture — but appropriate assessment is essential for safe long-term monitoring.

Why do they form? Risk factors

Aneurysm formation reflects a combination of genetic susceptibility and environmental influences. Major risk factors include:

Arterial hypertension
Smoking
Family history of aneurysm or subarachnoid hemorrhage
Genetic disorders (e.g., ADPKD, Ehlers–Danlos syndrome)
Female sex and age over 50 years

Importantly: you are not to blame for the development of an aneurysm. Our role is to minimize future risk through evidence-based care.

Are there symptoms?

In most patients, unruptured aneurysms are entirely asymptomatic. They are typically discovered incidentally on MRI or CT performed for other reasons (dizziness, headache, trauma, etc.).

More rarely, large aneurysms may cause:

Pain or pressure behind the eye
Double vision or eyelid droop (compression of the third cranial nerve)
Visual disturbances or seizures

How is the diagnosis made and monitored?

Diagnosis is established with vascular imaging of the brain:

MRI/MRA: radiation-free, ideal for initial assessment and follow-up.
CTA (CT angiography): excellent visualization of vessels and aneurysm morphology.
DSA (Digital Subtraction Angiography): gold standard when maximal detail is required, particularly before intervention.

Based on these studies, your individualized rupture risk is estimated (e.g., using the PHASES score), and management is discussed in detail with you.

When is treatment necessary?

Intervention is recommended when the anticipated risk of rupture exceeds the procedural risk. Factors considered include:

Size, morphology, and presence of “blebs”
Location (e.g., ACom, PCom, posterior circulation = higher risk)
Patient age and overall health
History of prior rupture of another aneurysm
Documented growth or new symptoms

For low-risk aneurysms, the safest option is often careful surveillance with scheduled imaging.

What treatment options are available?

When treatment is considered safer than observation, the principal options include:

Endovascular coil embolization – via catheter, the aneurysm is packed with microcoils to exclude it from the circulation.
Flow-diverting stents – specialized stents redirect blood flow along the parent artery, leading to gradual thrombosis of the aneurysm.
Microsurgical clipping – through craniotomy, a clip is placed across the aneurysm neck, permanently excluding it from circulation.

Treatment selection is individualized and determined by a specialized neurosurgical and endovascular team after a comprehensive risk–benefit analysis.

What should I expect before & after treatment?

Prior to intervention, a detailed preoperative evaluation, laboratory testing, and advanced angiographic imaging are performed. You will receive thorough counseling regarding the procedure type and anticipated hospital stay.

After treatment:

Observation in a monitored unit or ICU for the first 24 hours
Gradual mobilization, pain control, and neurological assessment
Follow-up angiography or MRI/MRA in selected cases

What is recovery like & what is the long-term outlook?

In most patients who undergo successful treatment (endovascular or microsurgical), prognosis is excellent and daily activities are gradually resumed.

After endovascular embolization, return to light activity typically occurs within days. After craniotomy, full recovery may require several weeks.

Daily life & lifestyle after diagnosis

Key goals:

Optimal blood pressure control
Complete smoking cessation
Moderate alcohol consumption
Gradual return to exercise with individualized guidance
High-quality sleep and stress reduction

Most forms of work and travel are permitted, following discussion with your care team.

When should I seek immediate medical attention?

Sudden, severe, “different” headache
New double vision, eyelid droop, or visual disturbance
Acute limb weakness, speech difficulty, or confusion
Repeated vomiting or loss of consciousness

In such cases, call emergency services immediately (166) and do not drive yourself.

What should I ask at my next visit?

Do you need personalized guidance for an intracranial aneurysm?

The Neuroknife team is available for imaging review, second opinions, and coordination of specialized endovascular or microsurgical treatment when indicated.

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