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Updated: May 23, 2026

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
[Very small intracranial aneurysms: Clip or coil]
F Signorelli1, F Scholtes, M W Bojanowski
1Division of Neurosurgery, Department of Surgery, hôpital Notre-Dame, centre hospitalier de l'université de Montréal, 1560, Sherbrooke St. East, Montreal, Quebec, Canada H2L 4M1.
Very small aneurysms (≤3mm) pose significant treatment challenges and carry higher rupture and mortality risks. Further research, including prospective trials, is needed to optimize treatment strategies for these challenging cases.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Cerebrovascular Disease
Context:
- Very small aneurysms (≤3mm) are increasingly diagnosed due to advanced imaging.
- These aneurysms present unique anatomical and fragility challenges for treatment.
- Subarachnoid hemorrhage can result from even tiny aneurysms.
Purpose:
- To review current literature on the treatment of very small aneurysms (≤3mm).
- To discuss treatment indications and strategic choices for occluding these aneurysms.
- To identify gaps in knowledge and suggest future research directions.
Summary:
- Literature review excluded arterial dissections and blister aneurysms.
- No studies specifically assessed surgical treatment for very small aneurysms.
- Endovascular treatment studies are retrospective, small, and prone to bias, indicating higher risks for small aneurysms.
Impact:
- Very small aneurysms demonstrate higher rupture and mortality risks compared to larger ones.
- Advanced endovascular tools may mitigate some treatment risks.
- A call for prospective randomized trials to establish optimal treatment for indicated very small aneurysms.
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