SynthesisNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025
Natural history and treatment of asymptomatic unruptured carotid cavernous aneurysms: a systematic review and meta-analysis.
Synthesis in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe management of asymptomatic carotid cavernous aneurysms (CCAs) is debated. While their rupture risk is low, the potential for growth and symptom development creates a clinical dilemma, particularly with the evolution of advanced endovascular treatments. This study aims to synthesize the evidence on the natural history of asymptomatic CCAs and the outcomes of intervention.
methodsA systematic review of PubMed and Scopus was conducted per PRISMA guidelines. We included retrospective studies reporting on the management of asymptomatic CCAs with five or more patients. A proportional meta-analysis was performed to calculate pooled outcomes for conservative and active management cohorts separately, as the observational nature of the included studies precluded direct comparative analysis.
resultsEleven studies met the inclusion criteria, encompassing 557 patients. Conservative management was the initial strategy in 75.0% of cases (n=418), while 25.0% (n=139) underwent active treatment. In the conservatively managed cohort, 8.1% of patients developed new neuro-ophthalmic symptoms. Radiologically, 91.5% of followed aneurysms remained stable. Aneurysm size was the strongest predictor of progression, with large aneurysms (≥12 mm) showing a 19.2% annual growth risk. Active treatment achieved a pooled aneurysm occlusion rate of 85.7% but was associated with complications, including a 2.9% rate of ischemic events.
conclusionThe natural history of asymptomatic CCAs is largely benign, but progression is strongly linked to aneurysm size. Our findings support a risk-stratified approach: conservative management with serial imaging for small (<12 mm) aneurysms and consideration of intervention for larger or growing lesions.
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