Cerebrovascular disease: Edited by Cornelius Weiller and Jens FiehlerIncidental intracranial aneurysms: rationale for treatmentRaymond, JeanAuthor Information Interventional Neuroradiology Research Unit, Department of Radiology, Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Canada Correspondence to Jean Raymond, MD, CHUM, Notre-Dame Hospital, Interventional Neuroradiology (NRI), 1560 Sherbrooke east, Pavilion Simard, room Z12909, Montreal, Quebec H2L 4M1, Canada Tel: +1 514 890 8000 ext 27235; fax: +1 514 412 7621; e-mail: [email protected] Current Opinion in Neurology: February 2009 - Volume 22 - Issue 1 - p 96-102 doi: 10.1097/WCO.0b013e32831fee91 Buy Metrics Abstract Purpose of review The review critically appraises the available evidence and current rationale for treating incidental intracranial aneurysms. Recent findings The rationale for treating incidental intracranial aneurysms uses comparisons between the so-called natural history, provided in a recent meta-analysis, and risks of treatments. Some risk factors for ruptures were identified (age >60, female sex, size >5 mm, posterior circulation aneurysms), but study quality is poor and relative risks are modest, of borderline statistical significance. Summary The medical literature cannot provide reliable numerical data of sufficient precision and quality to feed mathematical models of prediction of potential treatment benefits. Hence, the rationale fails to justify increasingly used treatments. A different approach using randomized trials is now in order. © 2009 Lippincott Williams & Wilkins, Inc.