Determining the critical size of intracranial aneurysm predisposing to subarachnoid hemorrhage in the Saudi population

INTRODUCTION: Aneurysmal subarachnoid hemorrhage (SAH) is a devastating event with a high rate of morbidity and mortality. With the improvement of diagnostic modalities and the adoption of different screening strategies, more aneurysms are being diagnosed prior to rupture. Based on large multi-center trials, size has become the most important determinant of treatment decisions. Unfortunately, these studies did not take into account the regional and racial variations, challenging the generalizability of their results. MATERIAL AND METHODS: We conducted a retrospective analysis on a series of 192 patients harboring 213 aneurysms. RESULTS: The critical finding in our study is that the majority of patients presenting with SAH due to ruptured aneurysms are <10 mm in size. CONCLUSION: Decision to treatment of a given unruptured intracranial aneurysm should be individually assessed and not taken from general international literature as this may mistakenly apply factors from one population to another.