Aneurysm size and location? To treat or not to treat?

Hello, I have a small (3mm) aneurysm and am awaiting results of my 6 month follow up as they decided to watch and wait, as with most small aneurysm's from what I'm reading here. I'm curious what size aneurysm people have and what they're doing with it, watch or treat? If you have a small aneurym and had it treated, why? Mine's an MCA with a wide neck. I was told they're very common and don't rupture so no worries but I can't help but be curious.


Hi Mitch,

I have a 4mm on the watch n wait, and have been told that at present the size is too small for surgery, and if it doesn't grow shall never require surgery. I also had a 8mm Left ICA coiled in April 2011 which was too risky to leave, not due to size, but location. So I'm feeling that its not just the size, but location and whether the risk of surgery out weighs the risk of rupture. Hope this helps :)

Best Wishes


Mitch, In 08 they found a 2mm. Advised to watch. It is now 5mm with large neck. I have dr. appt. Aug. 2nd to talk to yet another dr. about surgery. Mine is on right side cariod artery. Was told by one dr. it's in hard to reach place. I am seeking surgery at this time because it has grown and I have daily headaches that seem to be getting worse. If I didn't have the headaches I probably wouldn't be as concerned. Oh, anni is now 5mm with neck being 3mm.

Just read the post about gluing and will be asking if that is something that would work for me.

I didn't worry about mine until it became a 5mm.

Hi Mitch...I have a 2mm annie behind my left eye they are watching...too small at this point to do anything I am told...I had coiling done on a 9mm leaky annie that was on my basilar was needed I was told "sooner then later" angio will be in 1 year...all looked good at my 6 mos...

Hope this helps...Fondly Colleen

Hi All!

I'm new to the site, and am so glad I found all of you! I have a newly diagnosed 3mm annie behind my right eye and am getting mixed signals from Docs. The Interventional Nuero-radiologist told me the same things you were told Mitch, but the Neurologist is more concerned. They found my annie while doing tests after my TIA. To further complicate matters I am on Coumidin for a clotting disorder, which heightens the risks during surgery. Any suggestions?

Hi all and thanks for your replies. Laurie: I think you should get another opinion, maybe from a neurosurgeon. At my first appt, as I posted, I was told no biggie. At my 6month follow up they weren’t quite so casual about it. I was told because of the location and size, I would need a craniotomy/clipping to fix it and I was given the choice and if no treatment, it’s crucial to get it checked yearly. At first they said they don’t consider treatment until it’s 7mm so size appeared to me to be the only factor. However, as I read here, there are other considerations. Maybe if you get 2 opinions that are the same, it’ll set your mind at ease. I am just now wrapping up a 19 day severe headache/migraine? My internist told my sister yesterday to call 911 and have me taken to the hospital! I didn’t go and today it’s finally getting better… but with these headaches, the annie continues to be on my mind (forgive the pun). However, the neurosurgeon said simply go to the hospital if you get “the worst headache of your life” and I’ll know when/if that happens. Ultimately, they can never guarantee it won’t rupture, can only give you statistics and their educated opinions. Good luck to you and welcome!

Thanks Mitch! It’s good to hear you are finally finding some relief from your headache. It seems we all get the same information upon discovery of the annie. I am learning even small annies may rupture, and the statistics do not give me confidence or comfort. I am beginning the process of finding a Neurosurgeon who specializes in annie’s. Thanks again for the suggestion!

I had a 5mm clipped and have a 2.8 on the watch and wait plan. Aside from size the size in relation to the artery the aneurysm it is on is important. My 5mm one was on a small 2mm artery. I think location is also important both in regards to likleyhood of rupture as well as ease/difficulty of treatment. Mine was located in the back down near the circle of willis.

Hi Mitch,

I have a 2mm left side ICA@ophthalmic artery annie which is on the watch and wait list. My NS told me it is more dangerous to try to fix it, due to its location, than to leave it alone and watch. He did say that if it grew to 5mm or more, we would discuss putting a PED in. BTW I had a PED procedure in June, 2011 on the right side ICA@ophthalmic artery which was 9mm. 10 weeks post op and still going strong! I believe that as others have said, it depends on the annie and its location. Best to seek a 2nd opinion if you are uncomfortable with the first! Put your mind at ease and it will help heal your brain!

Best Wishes,


Hi Mitch,

I had an 8mm on my right MCA. I had no choice but to have it clipped as coiling was not an option due to the very wide neck. My surgeon performs both techniques so I didn't question him. He said IF we could coil that's the way we would be going. My understanding was my anni was a risk for rupture, it was further complicated by affecting 3 arteries in total. My neurosurgeon did NOT ever say that they are very common and don't rupture. I would be looking for another opinion if I was in your shoes. Keep us posted



I have known others that were able to keep a close watch on it, and have never had a problem. Mine was discovered because of a bad car accident with a drunk driver. I had a 5mm with unusual growth to 16mm wide neck basilar tip that because of location had to have immidate surgery and the only option was to coil. Both my Neuro. and Interventional Nuero-radiologist were of the same opinion with a very slim survival rate of rupture=10 min. max. to death. My Neuro. was board certified in vascuar neurology. It has a lot to do with location, size, growth rate of the anni. and risk of surgery vs. rupture.

I know it can be very disconcerting, but consider your options, get a second opinion if you feel it necessay, do research on your anni, and make the best decision for you.

Keep us posted,

Cheryl Johnson

Thanks for the info all. I feel silly getting a 2nd opinion when everyone around me keeps saying it's no big deal. I guess I shouldn't care if I seem like a hypochondriac, I simply do best with more information. I've done the research online and don't feel confident that I understand what I'm reading/seeing. My doc seemed reluctant to discuss any specifics about the annie I guess because it's so small. I made the call today to get a referral for a 2nd opinion, if for nothing more than to just get a better understanding of what I have where. Then maybe I can let it go until next year when I have to get tested again. I know how lucky I am and am grateful no problems other than headaches and tinnitus (sp?) which I'm told have nothing to do with the annie anyway!

I really appreciate all your input and am thankful I have this one and only place to feel it's OK to think about this thing. Best to you all. Mitch


"I feel silly getting a 2nd opinion when everyone around me keeps saying it's no big deal. I guess I shouldn't care if I seem like a hypochondriac" - There is a saying 'Minor surgery is when it happens to you, major surgery is when it happens to me' Don't let anyone make you feel like your crazy for doing what is right for you. Also a hypochondriac is an abnormal condition charaterized by a depressed emotional state and imaginary ill health. You are not imagining this health condition, it is real!!

Don't feel silly!!! This is your health!!! You don't seem like a hypochondriac at all. It seems to me that your doctor hasn't addressed your concerns or helped you understand what is going on. It is a bigger concern if you see your doc as reluctant to discuss it with you. I would feel the exact same way as you. There is already enough anxiety about finding out you have a anni, but add to that confussion and the stress level climbs.

I am glad you decided to get a 2nd opinion. I found it helps to write down questions to ask before the appt. It helps things go smoother. Dr's have different bedside manners, you need to find a good fit for you. You are your only & best advocate.

God Bless,

Cheryl Johnson

I have a 5mm x 3mm right ICA aneurysm and have just seen three neurosurgeons who have all recommended surgery (clipping) even though it is smaller that 7mm. This is because of it's location which has a slightly greater risk of rupture than similar small aneurysms, my age (44yrs) and the irregular shape.

Now all I have to do is decide which surgeon?

Wow Wendy, that would seem to me to be a difficult decision unless 1 just clicked more than the others. I know a number of people have posted on this site they had a clipping and didn’t have to have their head shaved. I know that’s what I would prefer. Good luck in your decision making and with the surgery. Best wishes for a speedy recovery! Mitch

Hi all. In my reading about smaller annie's on the internet, I'm seeing often that the older you get the more reluctant doctors are to recommend treatment. I guess they figure unless your annie is obviously high risk (which my doc said he cant tell???) or has leaked/ruptured, the stats show you may die from something else before the annie can get you? I have to say I never felt "old" until NOW! I am 52 and still didn't feel like a grown-up... until now. I'm scared to wait for the annie to meet their criteria for treatment if ever and I'm scared to elect treatment that I don't need right now. However, the younger you are the better and faster you heal. And, who knows if I'll have insurance or even a job later if I ever need surgery. I guess I have to obsess about stuff like this and get all the info I can and then I'll just have to let it go. Feels like I'm dealing with the 7 stages of grief only the loss is my youth! Although I'm also dealing with my mom's recent death. There's so much more to dealing with an unruptured small annie for me than just saying "oh it's small just forget about it, no big deal". I had to grow up too! :) Hope everyone has a great weekend!


Please don't let anybody ever tell you that an aneurysm is no big deal!! If you are not comfortable with your doctor, then you need to find another, it is that important.

In some cases, such as mine, and yours, migraines have nothing to do with the annie, which can be quite confusing at times, but I guess you just need to know your migraines?? If your headaches change, call the doctor!

Family history is also key, I found out about mine because my brother had an annie that ruptured, so our family had to be screened. I had mine coiled, and then a few years later I had to have a stent put in. I still have a small one that hasn't changed much over the past few years, so we are just watching it for now.

There are support groups out there that you can go to, to help you understand, you can talk to people, face to face....they are wonderful, as is this site.

No one can understand what "we" go through, except "us".

Take care of yourself

Mary Crockett


Hi Mitch,

You have hit the nail on the head about how I feel about my watch and wait annie!! What exactly is considered old? I am 50 years old and although sometimes I feel much older, sometimes I feel like I'm still 20 (at least in my mind!!!!!). The thing that bothers me most is the "just forget about it until we need to worry about it" attitude that doctors have regarding the smaller annies. Mine is 2mm on the ICA @ the ophthalmic artery and sometimes I feel as though my head will explode thinking about it.

Thank you for expressing your feelings on this. I'm right there with you!



This all gets so confusing...a local peer had multiple aneurysms on the mca and one ruptured...and the diagnosis of the others came thru w/the diagnosis of the ruptured one. I do not know the size...except that it was larger than the other two. However, her neuro followed up w/surgery on the smaller...I cannot remember if they did both of the smaller.


How did yours get tested/diagnosed? Was it from specific symptoms or?

My big question, now that the monitoring practice has become so established, it seems like so many are getting early diagnosis...but there's a lot of profit in monitoring, from the f/up rad testing, to the larger it gets, the more platinum it holds...

I am so happy for you to feel like 20...never let it go...