To clip or not to clip

I have been told by my neurosurgeon that he needs to clip, my aneurysm is 1mm and the have not been able to coil it, so that leaves the clipping… At this point I have decided to do “nothing,” not sure what to do, I’m scared to not do it, but I’m more scared to do it! The Dr that talked to me about it, scared me!!! I’m not sure what to do… I need some insight…

Hi Yolieq,

1mm? Is there a reason the ani needs to be clipped or repaired at all? I was under the impression that 3mm and smaller are just watched? My ani was 7.5 mm and I chose the clipping because I knew I would carry to much stress knowing it was not 'fixed'. Can you tell us more about the need for repair?

Also, if I were you and it needed to be done then think about a 2nd opinion to ease your mind. Prayers for you. Jeanne

Thank you Jeanne, SO much for your quick response! I really appreciate it, since everybody I try to share this with cannot relate to it all… My neurosurgeon referred me to a second opinion, due to my continued headaches, which is the one that suggested the clipping. But I didn’t know about that 3mm or smaller are just watched. That explains why my neurosurgeon didn’t do any more to it. He did install a shunt, but he didn’t suggest surgery. That makes me feel better about my decision to do nothing for now. Thank you again.

YW. My reference to the 3mm is from what I've been told and read. How accurate that is I do not know. In your case you have to do what is good for you and just keep some sort of daily log on how your headaches are doing. I had no headaches and my ani was found by accident. No ani symptoms. I also was not forced into clipping. My surgeon said if I wanted we could do mri's 1x per year to keep a watch on it. I would assume you also can do that. Talk it out with him and hopefully you will find the answer you are comfy with. Best wishes. Jeanne

Hi Yolieq,

I would certainly suggest getting a second opinion as it sounds as though this particular Surgeon is someone you're none too comfortable with and yeah, with the size its a question... however, depending upon WHERE its located may have plenty to do with the necessity of needing a clipping , and the shape of the annie can be an issue too . I just saw my NeuroSurgeon last week and in conversation he did state that recent studies have concluded that the smaller aneurysms will let go as often as the larger ones do-(-he even seemed surprised!) But 1st off, aside from everything else , another opinion is warranted, and bring a list of questions with you and a friend or close family member ( I think sometimes they hear better then we do, considering its our brains they're talking about --which makes the whole thing all the more surreal) Peace to you Yolieq, none of this easy ! Janet

Hi yolieq- I recently found out about my aneurysm and I am weighing my options. I agree with getting a second or even third opinion. I have seen a neuro. who specialized in coiling. My annie is between 4-5 mm, but the shape and size of the neck is concerning. The doc referred me back to the neurosurgeon to discuss clipping. While I was freaked out before talking to him, I actually left there quite calm. I am seeing a different neurosurgeon tomorrow for another opinion and yet another neurosurgeon in a few weeks for yet another opinion. I am "interviewing" these doctors. I need to feel comfortable with them, feel like I can trust them, and also feel like I am Terri, not just another brain aneurysm patient.

Ask around. Talk to people. You may get some great referrals to other doctors. Only you can advocate for yourself. I wish you all the best.


The rate of growth of the aneurysm is what is really important. It could stay stable or grow. I can only attest to the devastating effects of a rupture however based on subjective outcomes read here when treated proactively before rupture you stand a better chance for a great permanent outcome. Ultimately it is your decision.

I’m going to talk to my Dr about the follow ups, he has not mentioned anything about that. Thank you!

Yes, I agree. I’m not too comfortable with this particular neurosurgeon. He sacred the living hell out of me!! He even said I was on denial when I said I wasn’t sure if I wanted to go through with the surgery for now… Thank you for your reply. I don’t feel so alone in this anymore…

I already got a second opinion and I sent out my films to Dr Michael Alexander at Cedar-Sinai here in LA area. He’s suppose to be one of the best neurosurgeons in the LA area. I’m waiting to hear from him. He’s suppose to get back with me as soon as he reviews my films. Thank you for your good wishes, I appreciate it.

My Annie is 1mm and it has closed 2mm… It was 3mm when it initially ruptured. I’m just so scared of the clipping surgery! I already had a surgery, I had a permanent shunt installed, and they have tried to coil it 3 times via angiogram, however because of the size and place they have not been able to… but now they’re saying I need the clipping, my aneurysm ruptured back in June 2012. I’m going to wait for my third opinion form Dr Michael Alexander @Cedar-Sinai, I’ve been told he’s really good, for now my hopes are on him… Thank you!

yolieq ..welcome...lots ofqustions..

What is the artery / segment?

Have you googled: cerebral artery anatomy ; cranial nerves anatomy ; cranial lobe anatomy ; other terms that come up...

What symptoms did you have seeking diagnosis?

Did the neurosurgeon cover the angio images with you?

Was coiling attempted, based on your comment "they have not been able to coil it"

Between googling and connecting here, you may write a good list of questions to ask the doctor(s)..

Best wishes / prayers for your right decision...


No, I haven’t researched any of that but I will…

I had NO symptoms before the rupture.
No, the neurosurgeon did not cover the angio images with me, should I ask him to?
Yes, there have been 3 attempts to coil it through 3 different angiograms.
I did seek a second opinion and currently seeking a third…
I will make sure I come well prepared to my next appointment, with a list of questions.
Thank you for your good wishes and prayers I’m sure grateful for this site and all of you.

Dr Alexander is my surgeon and I totally trust him. I hope that you get some clarity and consensus about what is the best way to proceed. Dr A is great.

also - who else did you go to?

My original neurosurgeon is Dr Salem @ Glendale Adventist, my second opinion is Dr Lee also @ Glendale Adventist. My third opinion is Dr. A, hoping for a good outcome once he reviews my films…

Did Dr A perform surgery on you? Did your Annie rupture like mine?

Can you share your experience with Dr A?

From what I have read...I would get a 2nd need to feel comfortable with what your Doctor...and that doesn't seem to be the case...if the aneurysm in your brain is not leaking...and other aspects of your life are being controlled to avoid rupture...I suggest you have another opinion with another Neurosurgeon.

Wishing you well ~ Colleen


My personal opinion...anytime we are told of condition/status of our brain/body; the images should be displayed during the explanation, from initial diagnosis to the procedure results.

We, the public, (not just us) are encouraged to maintain a basic med, treatment, reactions, current meds, prior meds, allergies, etc... emphasis is coming forward on listing all the radiatinon/type, eg; CT, MR, notes rad volume/time frame...

The Merck Manual "Radiation and Imaging" article updated 07/2012 has data on types of radi/x-rays and the volume of rad factors (right word?). It also notes contrast dye; aka media, materials, agents...The "ACR Manual on Contrast Media 2012" has detail on contrast; MedlinePlus/others have data; far less detailed...all online...

This year, I wrote "ask the doc" about rad, contrast and others...Kathleen told me the Board is looking for an expert to do a webinar on rad, and possibly including contrast. I begged/pleaded contrast be included because rad/contrast are hand in hand...

Prayers I am not frightening you, other members; compare to your vehicle...the engine poer and and maintenance...Vehicles may be more flexible in fluid changes/ variance than our circulatory systems can be... and, potential impacts on our organs.

Warm wishes and contineud prayer...that asking, learning, getting the explanations from our doctor(s) are helpful in decision processes and not stress...