In reference to your article, “Is neurosurgery referral warranted for small brain aneurysms?” by Paul V. Aitken, Jr (J Fam Pract. 2003; 52:560–563), may I refer you to an article by Dr. Russell et al.1 In this article, the researchers demonstrated that a larger volume of subarachnoid hemorrhage occur from ruptured small aneurysm than associated larger aneurysms. This translates to greater risk of vasospasm.
In my clinical experience, and most neurosurgeons’ experience generally, subarachnoid hemorrhages occur in aneurysms of less than 10 mm, and that most aneurysms that rupture are less than 10 mm in diameter.2
In regards to the recommendation from the Stroke Council of the American Heart Association, which based its data from ISUIA, one might consider what Dr Meyer noted in his editorial in Journal of Neurosurgery3 He noted that there was an underrepresented anterior communicating artery aneurysms—could it be that aneurysms hemorrhage and was not included in the study? This would certainly skew the data from ISUIA.
In conclusion: Given the above evidence, one may want to reconsider the statement that primary care physicians do not need to refer patients with small cerebral aneurysm (less than 10 mm).
Eric Quek, PA-C,
Department of Neurosurgery,
Doctors Medical Center, Modesto, Calif