Surgical Treatment Options for Unruptured Brain Aneurysms

Unruptured intracranial aneurysms can be treated via several surgical and endovascular approaches, selected based on aneurysm size, location, morphology, and patient factors.

1. Microsurgical Clipping

A titanium clip is placed across the aneurysm neck, excluding it from circulation while preserving parent artery flow. Preferred for accessible aneurysms (e.g., anterior communicating artery).

2. Surgical Trapping

Both ends of the aneurysm are ligated, isolating it completely. Used when clipping is unsafe due to anatomy (e.g., arterial junctions).

3. Endovascular Coiling

Minimally invasive. A catheter delivers platinum coils into the aneurysm sac via the femoral artery, inducing thrombosis. Ideal for posterior circulation (e.g., basilar artery) or complex anatomy.

4. Flow Diversion

A stent-like flow diverter is placed across the aneurysm neck, redirecting flow and promoting thrombosis/healing. Effective for wide-necked or fusiform aneurysms.

5. Bypass Surgery

Rare; creates a new vascular pathway to bypass the affected segment. Reserved for giant, complex, or multi-artery aneurysms.

Decision-Making

A multidisciplinary neurovascular team evaluates imaging, patient health, and rupture risk (e.g., PHASES score) to recommend the optimal approach.