Unrupturierte intrakraniale Aneurysmen

Around 1.5 million people in Germany live with an unruptured intracranial aneurysm. Most of them will never know about it and will remain asymptomatic. Pathogenetically, the risk factors smoking and high blood pressure are of particular importance, not only for the development but also the growth and rupture of aneurysms. Instead of previous generalizations about the risk of rupture, a more personalized estimate and counselling should be provided today, taking into account aneurysm-related factors as well as age, concomitant diseases and treatment risks. Scoring systems are available to this end. In most cases of incidentally discovered unruptured intracranial aneurysms, the 5‑year risk of rupture is low and lower than the ad hoc risk of preventive aneurysm repair with any method. If “watch and wait” is the initial preferred strategy, non-invasive follow-up of aneurysm morphology should be carried out in addition to risk-reducing conservative treatment that is indicated anyway.