In the surgical treatment of miliary intracranial aneurysm smaller than the diameter of the artery, there have been cases in which neck clipping was difficult or premature rupture occurred as a result of clipping. Thus cautious judgment is needed to choose the surgical technique. The appropriate surgical treatment of these cases was described on the basis of the experience of our clinic.
Among 588 patients with intracranial aneurysm that have been experienced up to the present, 29 had miliary aneurysm. These included five unruptured cases and 24 ruptured ones. Among the cases of ruptured miliary aneurysm, six were unoperated, three because of death and three did not agree to the operation as they had come to our hospital in the chronic term. In one of the unoperated cases, a small aneurysm was observed at the trifurcation of the MCA by autopsy, and rupture was also recognized by histological examination. It was difficult to diagnose the case as intracranial aneurysm. Of the 18 operated cases, clipping was performed in 12, clipping and coating in two, coating in two, wrapping in one and suture in one. It was because a clip could not be placed satisfactorily in one case and blood was seen from the neck of the aneurysm in another that both clipping and coating were performed. One case was wrapped with muscle pieces because a clip could not be placed.
