Walsh & Hoyt: Conclusions

Intracranial aneurysms occur with high frequency and have a significant impact on public health. Most aneurysms present with subarachnoid hemorrhage, but 10% cause symptoms by mass effect, distal embolization, or thrombosis. Early clinical recognition and the use of improved and improving diagnostic techniques permit accelerated intervention, which itself continues to improve, with resultant decrease in overall mortality and morbidity and improvement in long-term prognosis. Neuro-ophthalmic signs and symptoms are commonly seen with aneurysms presenting either with mass effect or subarachnoid hemorrhage. Aggressive treatment to prevent or reverse delayed secondary ischemia and endovascular techniques for both ruptured and unruptured aneurysms promise to have a continuing impact on the outlook for patients with intracranial aneurysms. Better prospective studies will refine those indications for intervention in patients with cerebral aneurysms. The greater morbidity percentages seen in the newer surgical series are likely associated with the attempt to quantitate function, such as the Rankin scale and other psychosocial parameters, although low functional morbidity continues to be reported (6%).