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Background and Purpose-The estimates on the prevalence and the risk of rupture of intracranial saccular aneurysms vary widely between studies. We conducted a systematic review on prevalence and risk of rupture of intracranial aneurysms and classified the data according to study design, study population, and aneurysm characteristics. Methods-We searched for studies published between 1955 and 1996 by means of a MEDLINE search and a cumulative review of the reference lists of all relevant publications. Two authors independently assessed eligibility of all studies and extracted data on study design and on numbers and characteristics of patients and aneurysms. Results-For data on prevalence we found 23 studies, totalling 56 304 patients; 6685 (12%) of these patients were from 15 angiography studies. Prevalence was 0.4% (95% confidence interval, 0.4% to 0.5%) in retrospective autopsy studies, 3.6% (3.1 to 4.1) for prospective autopsy studies, 3.7% (3.0 to 4.4) in retrospective angiography studies, and 6.0% (5.3 to 6.8) in prospective angiography studies. For adults without specific risk factors, the prevalence was 2.3% (1.7 to 3.1); it tended to increase with age. The prevalence was higher in patients with autosomal dominant polycystic kidney disease (relative risk [RR], 4.4 [2.7 to 7.2]), a familial predisposition (RR, 4.0 [2.7 to 6.0]), or atherosclerosis (RR, 2.3 [1.7 to 3.1]). Only 8% (5 to 11) of the aneurysms were Ͼ10 mm. For the risk of rupture, we found nine studies, totalling 3907 patient-years. The overall risk per year was 1.9% (1.5 to 2.4); for aneurysms ϭ10 mm, the annual risk was 0.7% (0.5 to 1.0). Key Words: subarachnoid hemorrhage Ⅲ aneurysms Ⅲ epidemiology Ⅲ systematic review U ncertainty surrounds the prevalence of unruptured saccular aneurysms on intracranial arteries. In angiographic and autopsy studies, estimates for prevalence vary between 2 and 90 per 1000.1,2 This wide range probably reflects methodological differences between studies: prospective or retrospective designs, diagnostic tools (angiography or autopsy), and study populations. Many studies have included patients with ruptured aneurysms, which results in too high a prevalence. On the other hand, studies reviewing routine autopsy records or angiograms of only a single carotid artery probably underestimate the prevalence. Accurate data on the prevalence of intracranial aneurysms are essential in evaluating the results of screening programs for aneurysms in patients with increased risk for SAH such as patients with ADPKD 3 or first-degree relatives of patients with SAH.4 Also, the management strategy for unruptured aneurysms is influenced by the prevalence; because the incidence of SAH has been properly assessed and is stable, 5 a higher than previously assumed prevalence of aneurysms would mean that unruptured aneurysms are less dangerous. We conducted a systematic review of all reports on prevalence of intracranial aneurysms and classified the data according to study design, diagnostic methods, and study population. To assess the accur...

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