Abstract
he management of very small intracranial aneurysms, meaning aneurysms 3 mm or less in diameter, remains T an active topic of controversy in neurosurgery. A lack of consensus exists among relevant landmark trials that supports clear guidelines in their management. Therefore, this specific pathologic condition pushes the envelope between science and art, from which technological innovation will play an important role in influencing management. Results from the International Study of Unruptured Intracranial Aneurysms support conservative management for small aneurysms 7 mm, given the low 5-year risk of rupture (8), yet aneurysms sized 5 mm accounted for 52% of ruptured aneurysm treated in the International Subarachnoid Aneurysm Trial (7). Interpreting this opposing evidence for use in clinical practice becomes even more difficult when one recognizes that metrics other than size influence the transition from unruptured to ruptured. This aneurysm subset clearly requires further study in both epidemiology as well as optimal surgical management.
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