Endovascular coiling versus microsurgical clipping for extremely small intracranial aneurysms: treatment strategies, complications, and clinical outcomes

Background: and purpose Extremely small intracranial aneurysms (ESIAs) with a diameter no more than 2 mm are great challenges in neurosurgery. This study analyzed the complications, angiographic results, and clinical outcomes of patients with ESIAs undergoing endovascular coiling (EC) and microsurgical clipping (MC) and aim to determine which treatment is more beneficial for ESIAs. Methods Data of patients with ESIAs treated with EC or MC were retrospectively analyzed from February 2013 to December 2020 in the neurosurgical department of our hospital. Follow-up imaging included computed tomography angiography or digital subtraction angiography, and patient recovery was evaluated using the Glasgow Outcome Scale (GOS). The primary outcome was GOS 6 months later. The secondary outcomes included GOS at discharge, aneurysm occlusion rate 6 months after treatment, and postoperative complications such as cerebral infarction, hydrocephalus, pulmonary infection, postoperative rebleeding, hepatic or renal insufficiency, and electrolyte disturbance. Results A total of 88 patients were included in this study, among which 48 patients were treated with EC and 40 patients were treated with MC. There was no difference in complications between the two groups, and the hospitalization time of EC group was shorter than that of MC group. But immediate postoperative angiography results showed that the occlusion rate of EC group was lower than MC group at discharge and 6 months later. There was no difference in GOS scores between the two groups at discharge and 6-month follow-up. Conclusion EC and MC treatments were alternative management for patients with ESIAs.