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[Ruptured tiny middle cerebral artery aneurysm].

Ichiro Kawahara1, Keisuke Tsutsumi, Takashi Fujimoto

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No Shinkei Geka. Neurological Surgery
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Ruptured tiny aneurysms, even in the middle cerebral artery (MCA), can occur due to fragile walls. New imaging is needed to assess this fragility and guide treatment for unruptured aneurysms.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • Increased detection of unruptured intracranial aneurysms with advanced neuroimaging.
  • Small aneurysms are often untreated due to low rupture risk, yet small ruptures still occur.
  • Middle cerebral artery (MCA) aneurysms have a lower rupture risk than others.

Purpose of the Study:

  • To identify factors predicting rupture in small aneurysms.
  • To report outcomes of treating ruptured tiny (<3mm) MCA aneurysms.

Main Methods:

  • Retrospective case series of 10 patients with ruptured tiny MCA aneurysms.
  • Surgical clipping was performed for all patients.

Main Results:

  • Nine out of ten patients had good outcomes after clipping.
  • One patient experienced a poor outcome attributed to pre-existing heart and kidney failure.
  • Aneurysmal wall fragility is a key factor in the rupture of tiny aneurysms.

Conclusions:

  • Fragility of the aneurysmal wall is a critical predictor of rupture.
  • Current methods are insufficient for determining surgical indication for unruptured tiny aneurysms.
  • Development of novel neuroimaging techniques to assess aneurysmal wall fragility is essential.