Disappearing saccular intracranial aneurysms: do they really disappear?

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Cerebral aneurysms exhibit dynamic evolution, with spontaneous regression or disappearance documented, particularly in giant intracranial aneurysms.
• Reappearance or regrowth of previously regressed or disappeared aneurysms is a rare phenomenon with limited case reports.

Purpose of the Study:

• To report a series of four cases of cerebral aneurysms that demonstrated regression or disappearance on sequential imaging.
• To highlight the rare occurrence of regrowth or reappearance in these aneurysms and discuss management strategies.

Main Methods:

• Retrospective review of four cases with cerebral aneurysms showing regression or disappearance on serial angiograms.
• Documentation of aneurysm morphology changes, size, and hemodynamic factors.
• Description of endovascular treatment for regrown aneurysms and follow-up for others.

Main Results:

• Four cases of cerebral aneurysms, including one giant aneurysm, showed spontaneous regression or disappearance.
• Two of these aneurysms subsequently demonstrated regrowth or reappearance and were treated endovascularly.
• Two cases are currently under surveillance, emphasizing the importance of monitoring.

Conclusions:

• The natural history of cerebral aneurysms is dynamic, involving potential regression and rare regrowth.
• Careful follow-up is essential for managing aneurysms that have regressed or disappeared, considering hemodynamic influences.
• Endovascular treatment is a viable option for managing recurrent or regrown aneurysms.