• Abdolkarim Rahmanian, Fariborz Ghaffarpasand, Ehsanali Alibai, Joham Choque-Velasquez, Behnam Rezai Jahromi, and Juha Hernesniemi.
• Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
• World Neurosurg. 2018 Feb 1; 110: e605-e611.

ObjectivesTo report the outcome of patients with very small intracranial aneurysm (VSIA) undergoing surgical clipping using a double-clip technique.MethodsThis cross-sectional study was conducted in Namazi Hospital, the main referral neurovascular center in Southern Iran during a 6-year period from September 2010 to March 2016. All patients with VSIAs (≤3 mm) undergoing surgery with double-clip technique were included. This technique reduces the clip slippage. The short- and long-term outcomes determined by Glasgow outcome score (GOS), modified Rankin Scale (MRS), and complications.ResultsOperations were performed on 32 VSIAs in 26 patients with a mean ± SD age of 55.7 ± 10.1 years. Middle cerebral artery was the most common location for VSIA (50.0%). There was no neck remnant, and the complete occlusion rate was 100%. The rate of intraoperative aneurysm rupture was 30.8%, and none of the patients experienced rebleeding. The 6-month mortality rate was 0% in ruptured VSIAs and 6.25% in unruptured VSIAs. Most of the patients had favorable outcomes (88.5%), and the overall mortality rate was 11.5%. The rate of permanent neurologic deficit was 10.0% in ruptured and 12.5% in unruptured VSIAs. Multivariate logistic regression analysis revealed no association between baseline and clinical characteristics and outcome in this series.ConclusionVSIAs are difficult to treat because of their small sizes; therefore, with a double-clip technique, one can reduce complications related to the treatment of small aneurysms.Copyright © 2017 Elsevier Inc. All rights reserved.

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