Commentary

Dr Beck et al have reported on the size of intracranial aneurysms that they have encountered in their practice over a 1.5-year period. Many ruptured aneurysms (more than 80%) were less than 10 mm, and there were no real size differences between the ruptured group and the unruptured cases. In an effort to rationalize this data with the International Study of Unruptured Intracranial Aneurysms data, the authors suggest that small ruptured aneurysms may represent a different population with different biologic properties when compared with small unruptured aneurysms. This interesting hypothesis remains unproven but may explain the conflicting data.

Unfortunately, the conclusions regarding 3-dimensional angiography as being superior to conventional 2-dimensional angiography in assessing the true size of an aneurysm dome are unsubstantiated by the data presented. It would be interesting to see a side-by-side controlled experiment to show that size calculations are smaller when 3-dimensional studies are performed.