Follow-Up Care for a 1mm Intracranial Aneurysm

Q: Follow-Up Care for a 1mm Intracranial Aneurysm

Hello： Generally, follow-up can include a neurosurgical evaluation fee. <br>Invasive examinations such as computed tomography angiography (CTA) and MRI may be covered by health insurance if they meet the symptoms and criteria provided by the insurance. <br>An at-pouching lesion t

What is a 1mm intracranial aneurysm?

Hello Dr.
Zhao, at the beginning of this year, I visited the neurology department at Hospital A due to persistent dizziness and decreased hearing in my left ear.
The doctor ordered a non-contrast MRI, which revealed a left-sided vestibular schwannoma and a 1mm aneurysm.
The report stated: "Circle of Willis showed in TOF sequence.
No evident stenosis noted.
A 1mm at-pouching lesion noted at right distal ICA inferior wall (11-9, 9-73~9-74) R/O aneurysm.
Suggest follow up." I noticed that the 'a' in at-pouching and the 'R' in R/O were incomplete, so I guessed the words; I'm not sure if I guessed correctly.

In early May, I underwent Gamma Knife treatment for the vestibular schwannoma at Hospital B, and I have a follow-up MRI with contrast scheduled for December 12 to monitor the schwannoma.
During the Gamma Knife treatment in early May, I asked the doctor to also check the 1mm aneurysm since a contrast MRI would be performed, but the doctor mentioned that the aneurysm might not have been visible due to (??? I forgot what the doctor said).

Could you please advise me on which specialty I should consult for follow-up or treatment of the 1mm aneurysm? What examinations should I undergo? Since the follow-up for the Gamma Knife treatment will involve an MRI every six months, does health insurance cover the follow-up for the aneurysm? Based on the English descriptions in the report, can we determine the location and risk of rupture for this aneurysm? Thank you.

Ms. Chen, 50~59 year old female. Ask Date: 2022/12/04

Dr. Zhao Shaoqing reply Neurosurgery

Hello: Generally, follow-up can include a neurosurgical evaluation fee.
Invasive examinations such as computed tomography angiography (CTA) and MRI may be covered by health insurance if they meet the symptoms and criteria provided by the insurance.
An at-pouching lesion typically refers to a condition at the origin of the internal carotid artery (ICA) and is not directly related to high-risk factors.
If you have any concerns, please visit the outpatient clinic at Changhua Hospital to monitor your health.

Reply Date: 2022/12/04

More Info

When it comes to the follow-up care for a 1mm intracranial aneurysm, it is essential to understand both the nature of the aneurysm and the appropriate medical specialties involved in its management. Given your situation, where you have been diagnosed with a 1mm aneurysm alongside a vestibular schwannoma (acoustic neuroma), it is crucial to have a structured approach to monitoring and treatment.

Medical Specialties Involved
For follow-up care of an intracranial aneurysm, you should primarily consult a neurosurgeon or a neurologist. Neurosurgeons specialize in surgical interventions for brain conditions, including aneurysms, while neurologists can provide ongoing management and monitoring. Depending on your specific case, you may also be referred to a vascular neurologist, who specializes in cerebrovascular diseases.

Recommended Follow-Up Procedures
1. Imaging Studies: The standard follow-up for an intracranial aneurysm typically involves imaging studies. Since your aneurysm is small (1mm), it may not require immediate intervention, but regular monitoring is essential. The recommended imaging techniques include:
- Magnetic Resonance Angiography (MRA): This non-invasive imaging technique can provide detailed images of blood vessels in the brain.

- Computed Tomography Angiography (CTA): This test can also visualize blood vessels and is particularly useful if there are concerns about the aneurysm's size or changes over time.

- Follow-Up MRI: As you mentioned, you will have an MRI with contrast. This can help in visualizing the aneurysm more clearly and assessing any changes since the last imaging.

2. Frequency of Follow-Up: For a 1mm aneurysm, follow-up imaging is generally recommended every 6 to 12 months, especially in the first few years after diagnosis. If there are no changes, the frequency may be reduced.

Insurance Coverage
Regarding insurance coverage for the follow-up imaging of the aneurysm, it is essential to check with your health insurance provider. Many insurance plans cover necessary imaging studies, especially if they are deemed medically necessary by your healthcare provider. It is advisable to discuss this with your doctor, who can provide documentation to support the need for follow-up imaging.

Risk Assessment
The report you received indicates that the aneurysm is located at the right distal internal carotid artery (ICA) inferior wall. The term "at-pouching lesion" suggests that it is a small outpouching, which is characteristic of a saccular aneurysm. Generally, smaller aneurysms (less than 5mm) have a lower risk of rupture compared to larger ones. However, even small aneurysms can pose risks, and their behavior can change over time. Regular follow-up is crucial to monitor for any growth or changes in the aneurysm's characteristics.

Conclusion
In summary, for the follow-up care of your 1mm intracranial aneurysm, you should consult a neurosurgeon or neurologist. Regular imaging studies such as MRA or CTA are essential for monitoring the aneurysm, and you should discuss the frequency of these studies with your healthcare provider. Additionally, check with your insurance regarding coverage for these follow-ups. Understanding the location and characteristics of the aneurysm can help assess the risk of rupture, but ongoing monitoring is key to ensuring your health and safety. Always feel free to ask your healthcare provider any questions or concerns you may have regarding your condition and follow-up care.

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