The fate of intracranial microaneurysms treated with bipolar electrocoagulation and parent vessel reinforcement

OBJECTIVE: Although direct clipping remains the treatment of choice for int racranial aneurysms, not all aneurysms can be clipped. This report reviews the results of bipolar coagulation followed by parent vessel reinforcement for the treatment of intracranial microaneurysms (maximal diameter of less than or equal to 3 mm), with immediate and delayed postoperative angiograph ic evaluation in all cases. METHODS: During a 1-year period, 20 intracranial microaneurysms in 12 patie nts were treated with bipolar electrocoagulation followed by reinforcement of the parent artery with muslin gauze. All patients underwent intraoperati ve or immediate postoperative angiographic evaluation, and all underwent fo llow-up angiographic evaluation approximately 1 year later. No patient was lost to follow-up monitoring. RESULTS: Microaneurysms involved the middle cerebral artery (eight eases), internal carotid artery (six cases), anterior cerebral/anterior communicati ng artery (five cases), and superior cerebellar artery (one case). In all c ases, the patient was undergoing a craniotomy for clipping of a larger aneu rysm, and the microaneurysms were treated concurrently. At the time of the immediate angiographic examinations, 19 of 20 (95%) microaneurysms were no longer visible and 1 was substantially smaller (< 1-mm irregularity on the parent vessel). No patient experienced an adverse event related to microane urysm treatment. In the 1-year follow-up examinations, there was no angiogr aphic evidence of recurrence in the 19 cases with complete obliteration; th e one residual aneurysm remained stable. CONCLUSION: At 1 year, direct coagulation followed by parent vessel reinfor cement seems to provide a satisfactory treatment option for intracranial mi croaneurysms.