Should Small Aneurysms Be Clipped? Single Center Experience

Background: Cerebral aneurysms prevalence may vary from 0.4–10%. The decision to treat or not incidental aneurysms remains controversial, especially when the lesions are small (< 5mm). There are many recent publications demonstrating that these lesions often bleed.

Methods: We reviewed admitted patients with angiographic studies submitted to intracranial aneurysms surgical treatment from April 2012 to July 2013 in Neurosurgery Department of São Paulo Medical School University (15 months), in order to define the rate and risk of bleeding. Additionally, we proceeded literature review with collected 357 papers (last 5 years) which were selected 50, that were focused on our research. Clinical patient’s status at the time of discharge was evaluated with the modified Rankin scale (mRS).

Results: A series of 118 cases of surgically treated aneurysms (clipped) was analysed: 26.3% male and 73.7%; Ruptured (61 cases – 51%); MCA (51 cases – 43%) was the more common aneurysm. Small size was (25 cases – 21%); that 2 died (16%), 3 (25%) with severe disability, restricted to bed and dependent on nursing care; blood pressure was the main risk factors (56%); and aneurysm less than 2 mm (100%) were ruptured.

Conclusion: The number of small aneurysms in our series was significant (25 cases – 21%) and its rate of bleeding was high (25 cases – 48%), resulting in death and disability in a significant number of cases. Our tendency is for the surgical treatment when it is associated with risk factors.

No conflict of interest has been declared by the author(s).