2019 Volume 24 Issue 2 Pages 150-156
Among the ruptured cerebral aneurysms that were embolized by the same surgeon between May 2015 and February 2018 at our hospital, we retrospectively analyzed the 12 consecutive cases with a small ruptured cerebral aneurysm measuring＜3 mm in maximum dimension. The five male and seven female patients’ mean age was 58.7 years. The aneurysms were classified into four types by location: anterior communicating aneurysm in six patients, anterior cerebral artery aneurysm in one, internal carotid aneurysm in two, and vertebrobasilar aneurysm in three. The grades according to the Hunt & Kosnik classification at the onset of aneurysm rupture were Grade I for three patients, Grade II for four, Grade III for two, Grade IV for two, and Grade V for one. Coil embolization was feasible in all patients. Post‒operative angiography revealed complete occlusion in nine patients, neck remnant in two, and dome filling in one. There were no complications related to procedures such as intraoperative rupture. One patient with a basilar tip aneurysm showed recanalization after 1.5 months. One patient with an internal carotid posterior communicating aneurysm showed recanalization after 16 months. Additional coil embolization were therefore performed in these two patients. At 90 days, the mean modified Rankin Score (mRS) was 1.57 (0‒6). However, one patient classified as Grade IV and one classified as Grade V had after‒treatment mRS values of 6 due to pneumonia and initial brain damage, respectively. At follow‒up (mean 19.3 months), no patients required retreatment other than the above‒mentioned embolizations, and no patients had rebleeding or other complications. The use of coil embolization for a small ruptured cerebral aneurysm measuring＜3 mm has become widespread as the development of devices has advanced and small‒diameter coils have become available. More intricate intravascular treatment techniques are now feasible for smaller aneurysms that previously were clipped. Small ruptured cerebral aneurysms rupture more frequently during surgery, and it is therefore advisable to individualize the treatment when coil embolization is used.
