From the Guidelines
For an 8 mm x 8 mm cerebral aneurysm, treatment is strongly recommended due to the significant rupture risk, and endovascular coiling or surgical clipping should be considered as the primary treatment options. The size of the aneurysm is a critical factor in determining the risk of rupture, and according to the guidelines for the management of patients with unruptured intracranial aneurysms from the American Heart Association/American Stroke Association 1, several factors should be considered in the selection of the optimal management, including the size, location, and other morphological characteristics of the aneurysm.
When considering treatment options, it is essential to weigh the risks and benefits of both endovascular and microsurgical treatment, as patients with unruptured cerebral aneurysms should be fully informed about the alternatives to secure the aneurysm and prevent bleeding 1. The results of treatment are inferior at low-volume centers, and hence treatment is recommended to be performed at higher-volume centers 1.
The choice between endovascular coiling and surgical clipping depends on various factors, including aneurysm location, shape, patient age, and overall health status. Data from prospective and retrospective studies indicate that microsurgical clip ligation may confer more durable protection against aneurysm regrowth, but coil embolization may be superior to surgical clipping with respect to procedural morbidity and mortality, length of stay, and hospital costs 1. Therefore, it may be reasonable to choose endovascular therapy over surgical clipping in the treatment of select UIAs, particularly in cases for which surgical morbidity is high.
However, in older patients (>65 years of age) and those with associated medical comorbidities with small asymptomatic UIAs and low hemorrhage risk by location, size, morphology, family history, and other relevant factors, observation is a reasonable alternative 1. For an 8 mm x 8 mm cerebral aneurysm, the treatment risk is significant, and treatment is necessary to prevent rupture, which results in high mortality and disability rates. Key considerations in the management of cerebral aneurysms include:
- Aneurysm size and location
- Patient age and overall health status
- Presence of medical comorbidities
- Family history of cerebral aneurysm
- Presence of multiple aneurysms or concurrent pathology
- Treatment options, including endovascular coiling, surgical clipping, and observation.
From the Research
Treatment Options for Cerebral Aneurysm
The treatment for an 8 mm x 8 mm cerebral aneurysm can be approached through two main modalities: surgical clipping and endovascular coiling.
- Surgical clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms 2.
- Endovascular coiling is associated with lower morbidity and mortality and a better postoperative course 2.
Comparison of Treatment Outcomes
Studies have compared the outcomes of these two treatment approaches:
- A meta-analysis found that endovascular coiling was associated with a shorter length of stay and a lower incidence of short-term complications compared to surgical clipping 3.
- However, surgical clipping showed a higher rate of complete occlusion after surgery and a lower rate of short-term retreatment 3.
- Another study recommended surgical clipping for unruptured middle cerebral artery aneurysms after careful consideration of patient, aneurysmal, and treatment center factors 4.
Size and Location Considerations
The size and location of the aneurysm are important factors in determining the treatment approach:
- Aneurysms larger than 5 mm in patients younger than 60 years of age should be seriously considered for treatment 5.
- Large, incidental aneurysms larger than 10 mm should be treated in nearly all patients younger than 70 years of age 5.
- Aneurysms originating from the proximal segment (A1) of the anterior cerebral artery are rare and challenging to treat, but can be managed with surgical clipping or endovascular coiling 6.
Treatment Recommendations
Based on the available evidence, the treatment approach for an 8 mm x 8 mm cerebral aneurysm should be individualized, taking into account the patient's age, aneurysm size and location, and other factors:
- Microsurgical clipping rather than endovascular coiling should be the first treatment choice in low-risk cases 5.
- A highly experienced cerebrovascular team of microneurosurgeons and endovascular neurosurgeons working at a tertiary medical center with a high case volume is critical for making treatment decisions 5.