title: Surgical Outcome of Patients with Very Small Intracranial Aneurysms: A Single-Center Experience from Southern Iran.
abstract: OBJECTIVE
  To report the surgical outcome of very small intracranial aneurysms (VSIAs; ≤3 mm) in a large referral neurovascular center in Southern Iran.
  
  
  METHODS
  This cross-sectional study was conducted in Southern Iran during a 6-year period between 2010 and 2016. We included all patients with VSIAs (≤3 mm) who underwent surgery in our center. All patients were operated on by a single neurosurgeon. Preoperative and postoperative computed tomography angiography and intraoperative imaging with indocyanine green video angiography were performed in all cases. The short-term and long-term outcome were determined by Glasgow Coma Scale (GCS) and modified Rankin Scale.
  
  
  RESULTS
  A total of 62 VSIAs in 52 patients were treated during the study period. There were no remnants and the complete occlusion rate was 100%. None of the patients experienced rebleeding. The 6-month mortality was 0% in unruptured VSIA, 3.8% in ruptured VSIA, and 5.7% in ruptured intracranial aneurysms other than VSIAs. Most patients had a favorable outcome (84.6%). An unfavorable outcome was associated with increased age (P = 0.027), higher rates of hypertension (P = 0.022) and ischemic heart disease (P = 0.023), lower GCS score on admission (P < 0.001), higher Hunt and Hess grade (P < 0.001), higher rate of preoperative ventriculoperitoneal shunt insertion (P = 0.040), and subarachnoid hemorrhage (P = 0.015).
  
  
  CONCLUSIONS
  Surgical clipping of ruptured and unruptured VSIAs is a safe and effective modality of treatment associated with low mortality and morbidity. Age, comorbidities (hypertension, ischemic heart disease), GCS score on admission, Hunt and Hess grade, preoperative ventriculoperitoneal shunt insertion, and subarachnoid hemorrhage are important predictors of outcome in patients with VSIAs undergoing surgery.
authors.affiliation: Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abdolkarim
authors.initials: A
authors.lastname: Rahmanian
authors.affiliation: Student Research Committee, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: fariborz.ghaffarpasand@gmail.com.
authors.forename: Fariborz
authors.initials: F
authors.lastname: Ghaffarpasand
authors.affiliation: Student Research Committee, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Nima
authors.initials: N
authors.lastname: Derakhshan
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007492:Iran; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Double-clip technique; Iran; Outcome; Surgical clipping; Very small intracranial aneurysms (VSIAs)