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Background <p>The 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.</p> Methods <p>A 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.</p> Results <p>Eleven 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.</p> Conclusion <p>The 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 (&lt;12 mm) aneurysms and consideration of intervention for larger or growing lesions.</p>

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Natural history and treatment of asymptomatic unruptured carotid cavernous aneurysms: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月20日

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  • Gianluca Trevisi,
  • Giovanni Pennisi,
  • Samuele Santi,
  • Nicola Montemurro,
  • Matteo Palermo,
  • Carmelo Lucio Sturiale

摘要

Background

The 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.

Methods

A 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.

Results

Eleven 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.

Conclusion

The 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.