Abstract
The UCAS Japan, the SUAVe Study, and the ISUIA have shown that the indications for surgical or endovascular treatment of unruptured small aneurysms and asymptomatic aneurysms in elderly patients require careful consideration. We describe three cases of intracranial aneurysms not indicated for surgical or endovascular treatment: a 3-mm middle cerebral artery aneurysm in a 36-year-old woman, a 4-mm pericallosal artery aneurysm in a 74-year-old woman, and an 8-mm posterior communicating artery aneurysm in an 83-year-old woman, which had all enlarged in the observation period and finally ruptured. All three patients had two or more risk factors for aneurysm growth or rupture identified by the UCAS Japan or SUAVe Study, indicating that careful follow-up monitoring for morphological changes in the aneurysm is mandatory, even for a small aneurysm, and especially in young patients with such multiple risk factors.
However, surgical indications are limited for elderly patients, even after aneurysm enlargement, so the appropriate treatment for elderly patients requires careful consideration of the clinical condition of the individual patient.
