Neurosurgical Consultations
The patient was subsequently seen by the neurosurgery service. In older adults, observation of such small and incidental aneurysms would be appropriate. However, because of her age, further evaluation of this unruptured incidental aneurysm was recommended, with input and recommendations from the local tertiary center. At the second neurosurgical consultation, headaches were persistent, but no new symptoms or neurologic deficits were noted.
MRA findings were reiterated, showing overall tortuous and ectatic blood vessels with associated multiple aneurysms, likely consistent with an incidental finding in the setting of her normal headaches. The neurosurgical/neurovascular team came to a unified conclusion that no intervention was indicated for the patient at this time and suggested that she undergo a repeat brain MRI/MRA in 6 months, followed by annual examinations if everything remains stable at the interval 6-month follow-up. Invasive cerebral angiography was specifically not recommended given its risks and her asymptomatic clinical status.