Treatment of unruptured intracranial aneurysms: Surgery, coiling, or nothing?

The decision of whether and how to treat an unruptured intracranial aneurysm (UIA) is complex. The goal in caring for patients with UIAs is to maximize their duration of high-quality life by optimally balancing the risks of aneurysm rupture-the "natural history" of the aneurysm-with those of treatmentrelated adverse outcomes. In this article, we review the literature concerning the natural history of UIAs and summarize the procedure-associated morbidity and mortality and efficacy of surgical clipping and endovascular coiling. Using this information, we make recommendations regarding the optimal management of patients with UIAs.