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Incidental Microaneurysms During Microvascular Surgery: Incidence, Treatment, and Significance

Sung Ho Lee1, Byung Duk Kwun2, Jiwook Ryu2

  • 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

World Neurosurgery
|September 3, 2019
PubMed
Abstract

Insights

Incidental microaneurysms (IMAs) are found in 6.4% of cerebral microsurgeries. Early detection during surgery, especially for patients with multiple aneurysms, is crucial for effective treatment.

Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Medical Imaging

Background:

  • Advanced imaging detects smaller aneurysms, but angiographically negative microaneurysms persist in cerebral microsurgery.
  • Limited data exists on the incidence and treatment efficacy of these microaneurysms.

Purpose of the Study:

  • To investigate the incidence and treatment of incidental microaneurysms (IMAs) over a 5-year period.
  • To identify risk factors and outcomes associated with IMAs detected during microsurgery.

Main Methods:

  • Retrospective analysis of 484 surgical cases (subarachnoid hemorrhage and unruptured aneurysms) over 5 years.
  • Inclusion criteria: microsurgery via transsylvian approaches and preoperative digital subtraction angiography.
  • IMAs defined as aneurysms invisible on preoperative angiography but detected during surgery.

Main Results:

  • A 6.4% incidence of IMAs was observed (33 aneurysms in 31 cases).
  • Multiple aneurysms significantly increased the risk of IMA identification (P < 0.001).
  • IMAs were successfully treated with clipping (18 cases) and wrapping (15 cases) without complications.

Conclusions:

  • The study identified a 6.4% incidence of IMAs, though this may be an underestimate.
  • Careful intraoperative inspection can lead to early IMA detection, particularly beneficial for patients with multiple aneurysms.
Keywords:
AneurysmAneurysm neck clippingAngiographyBrain

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