Surgical Clipping of Very Small Unruptured Intracranial Aneurysms: A Multicenter International Study

Neurosurgery
Michaël BruneauJuha Hernesniemi

Abstract

Treatment of very small unruptured intracranial aneurysms (VSUIAs, defined as ≤3 mm) can be indicated in selected circumstances. The feasibility and outcomes of endovascular therapy for VSUIAs have been recently published; however, the efficacy and complication rate of surgical clipping has not been reported in any large series to date. We conducted a multicenter study to examine surgical outcomes for VSUIAs. All consecutive patients undergoing surgery for a VSUIA in 4 neurosurgical centers between October 2001 and December 2012 were retrospectively analyzed. In the study, 183 patients (128 women, mean age 51.3 years) were treated with 190 procedures for a total of 228 aneurysms. Most were anterior circulation aneurysms (n = 215). The majority were directly clipped (n = 222, 97.4%), with coagulation or wrapping in the remainder. After 1 reoperation for incomplete clipping, postoperative imaging of 225 aneurysms confirmed complete occlusion in 221 (98.2%), 1 neck remnant (0.44%), and 3 partial occlusions (1.3%). Mortality was 0%. Early postoperative neurological deficit developed in 12 patients (6.6%); posterior circulation location was a significant risk factor for early neurological deficit (P < .001). Middle cerebral artery a...Continue Reading

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Citations

Jul 2, 2017·Stroke; a Journal of Cerebral Circulation·Philippe BijlengaKarl Schaller
Jul 1, 2020·Neuroradiology·Haishuang TangQinghai Huang

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