Small aneurysms should be clipped?

Gustavo Noleto; Nícollas Rabelo; Leonardo Abaurre; Hugo Neto; Mario Siqueira; Manoel Teixeira; Eberval Figueiredo

doi:10.4103/ajns.AJNS_161_18

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(02): 422-426
DOI: 10.4103/ajns.AJNS_161_18

Original Article

Small aneurysms should be clipped?

Authors

Gustavo Noleto

Department of Neurosurgery, University of São Paulo Medical School, São Paulo
Nícollas Rabelo

Department of Neurosurgery, University of São Paulo Medical School, São Paulo
Leonardo Abaurre

Department of Neurosurgery, University of São Paulo Medical School, São Paulo
Hugo Neto

Department of Neurosurgery, University of São Paulo Medical School, São Paulo
Mario Siqueira

Department of Neurosurgery, University of São Paulo Medical School, São Paulo
Manoel Teixeira

¹Department of Neurosurgery, São Paulo University, São Paulo
Eberval Figueiredo

Department of Neurosurgery, University of São Paulo Medical School, São Paulo

Abstract

Background: Cerebral aneurysm prevalence may vary from 0.4% to 10%. The decision to treat or not incidental aneurysms remains controversial, especially when the lesions are small (<5 mm). Many recent publications are demonstrating that these lesions often bleed. Methods: We reviewed admitted patients with angiographic studies submitted to intracranial aneurysm surgical treatment from April 2012 to July 2013 in the Neurosurgery Department of São Paulo Medical School University (15 months), to define the rate and risk of bleeding. In addition, we proceeded literature review with collected 357 papers (past 5 years) which were selected 50 that were focused on our research. Clinical patients' status at the time of discharge was evaluated with the modified Rankin scale. Results: A series of 118 cases of surgically clipped aneurysms was analyzed: 73.7% woman; Ruptured (61 cases, 51%); middle cerebral artery (51 cases, 43%) was the more common aneurysm. Small size (<5 mm) 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 an aneurysm <2 mm (100%) was 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 surgical treatment when it is associated with risk factors.

Key-words:

Aneurysm clipped - cerebral hemorrhage - intracranial aneurysm - small cerebral aneurysm - subarachnoid hemorrhage

Full Text

References

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