[Growth of asymptomatic unruptured aneurysms in follow-up study: report of three cases].

The natural history of asymptomatic unruptured aneurysms that have not been subjected to surgery was studied radiologically using MRA and MRI and 3D-CT angiography (3D-CTA) commencing in 1993. We report on the growth of documented asymptomatic unruptured aneurysms in three patients. Growth of the aneurysms was followed by repeated MRA, MRI and 3D-CTA. In Case 1, a 71-year-old woman had been diagnosed as having a 3 mm unruptured anterior communicating artery aneurysm. The size of the aneurysm had expanded to 4 mm, 2 years later. This was detected during a follow-up MRA and confirmed by angiography. After this follow-up MRA, the aneurysm showed no change in size or shape for 8 years. Case 2 was that of a 75-year-old woman who had a 4.5 mm aneurysm involving the basilar artery and the superior cerebellar artery. 12 months later, an MRA was carried out as a follow-up study. This MRA revealed that the aneurysm had developed a bleb and was expanding. 8 months later the patient bled from the aneurysm and underwent surgery, but died. Before surgery, the diameter of the aneurysm, confirmed by angiogram, was 5.5 mm including the bleb. The third patient was a 66-year-old woman who had a 7 mm internal aneurysm involving the carotid artery and the posterior communicating artery. 3 years later a 3D-CTA detected the expansion of the aneurysm and development of an aneurysm bleb. 6 years later more expansion occurred and 3 months after that the patient bled from the aneurysm and underwent clipping. At that time, the diameter of the aneurysm, confirmed by angiography, was 13 mm including the bleb. In this follow-up study, patients with diagnosed asymptomatic unruptured aneurysms were followed up by MRA and MRI and 3D-CTA to determine risk factors for aneurysm rupture. We emphasize the fact that growth of an unruptured aneurysm and formation of blebs are important risk factors of aneurysm rupture.