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Shedding light on tiny intracranial aneurysms: a retrospective risk assessment
Jennifer Sauvigny1, Safouh Muzaiek1, Patrick Czorlich1
11Departments of Neurosurgery.
Journal of Neurosurgery
|May 23, 2025
Summary
Tiny intracranial aneurysms (tiAs) pose rupture risks, especially those with irregular shapes. While current scores help, individualized treatment decisions are crucial for these small brain aneurysms.
Area of Science:
- Neurosurgery
- Neuroradiology
- Cerebrovascular disease
Background:
- Tiny intracranial aneurysms (tiAs) present diagnostic and management challenges.
- Treatment decisions for tiAs are controversial due to lack of clear guidelines.
- Rupture risk of tiAs is significant despite their small size.
Purpose of the Study:
- Investigate risk factors for rupture in tiny intracranial aneurysms.
- Analyze clinical decision-making for aneurysm repair in tiAs.
- Evaluate the utility of current scoring systems for tiA management.
Main Methods:
- Retrospective analysis of patients with aneurysmal subarachnoid hemorrhage (SAH) and unruptured intracranial aneurysms (UIAs).
- Selection of single tiAs (≤3 mm maximum diameter) for detailed analysis.
- Comparison of demographics, aneurysm characteristics, and risk factors between SAH and UIA groups.
- Retrospective application of modified UIA treatment score (UIATS*) and PHASES score.
Main Results:
- Irregular morphology (OR 4.53) and high size ratio (> 3/1.6; OR 14.73) were significantly associated with tiA rupture.
- UIATS* would have recommended intervention in 20.3% of ruptured tiAs versus 0.9% of unruptured tiAs.
- Intervention recommendations differed significantly between ruptured and unruptured tiAs, and between tiAs and larger aneurysms.
Conclusions:
- Ruptured tiAs were identified, but few met criteria for recommended treatment.
- Irregular morphology and abnormal configurations are critical factors for evaluating tiA rupture risk.
- Current scoring systems are valuable but require integration with individualized, multidisciplinary treatment approaches.
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