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  • Analysis of cases of aneurysms smaller than 5 mm operated at a tertiary hospital

    Final Number:

    Gustavo Noleto MD, PhD; Leonardo B Abaurre MD; Hugo Sterman; Eberval G. Figueiredo MD, PhD; Mario G. Siqueira MD; Wellingson S. Paiva MD PhD; Manoel Jacobsen Teixeira

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: The decision of to treat or not incidental aneurysms remains controversial, especially when the lesions are small. Although classical studies indicate a low rate of rupture in these aneurysms, there are many recent publications demonstrating that these lesions bleed with frequency.

    Methods: We analysed the cases of intracranial aneurysms operated in a period of 15 months in our Department, in order to define the rate and risk of bleeding of these small aneurysms. Simultaneously we proceeded to a qualitative literature review on the subject focusing on articles published in the last 5 years.

    Results: A series of 118 cases of surgically treated aneurysms (clipped) was analysed: 26.3% male and 73.7% female patients, with an average age of 54.1 years. Twenty five aneurysms were small and the incidence of rupture in this group was 48% (12 cases). Two of these patients died and 3 evolved with severe disability.

    Conclusions: The number of small aneurysms in our series was significant (21%) and its rate of bleeding was high, resulting in death and disability in a significant number of cases. Our tendency is to operate these lesions, ruptured or not.

    Patient Care: Understanding the natural history of aneurysms smaller than 5 mm may help patients with these vascular lesions, avoiding complications associated with these aneurysms

    Learning Objectives: To describe the management for incidental cerebral aneurysms smaller than 5 mm To describe the prognosis in subarachnoid hemorrhage associated with small aneurysms

    References: 1: Stetler WR Jr, Wilson TJ, Al-Holou WN, Chaudhary N, Gemmete JJ, Thompson BG, Pandey AS. Conventional endovascular treatment of small intracranial aneurysms is not associated with additional risks compared with treatment of larger aneurysms. J Neurointerv Surg. 2014 Mar 12. 2: Schaafsma JD, Velthuis BK, Vincken KL, de Kort GA, Rinkel GJ, Bartels LW. Artefacts induced by coiled intracranial aneurysms on 3.0-Tesla versus 1.5-Tesla MR angiography-An in vivo and in vitro study. Eur J Radiol. 2014 Feb 5. pii: S0720-048X(14)00066-7. 3: Hong Y, Wang YJ, Deng Z, Wu Q, Zhang JM. Stent-assisted coiling versus coiling in treatment of intracranial aneurysm: a systematic review and meta-analysis. PLoS One. 2014;9(1):e82311. 4: Knap D, Gruszczynska K, Partyka R, Ptak D, Korzekwa M, Zbroszczyk M, Baron J. Results of endovascular treatment of aneurysms depending on their size, volume and coil packing density. Neurol Neurochir Pol. 2013;47(5):467-75.

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