Small aneurysms follow up or get treated?

I am diagnosed with two small aneurysms 2mm on left median artery vertebralis and approximately 4mm one on the basilar artery directed towards left I had just headache which doctors say can not be due to aneurysms and I was diagnosed by chance on MR angiography. I have had several appointments and doctors are more concerned with the one on the basilar artery but they suggested an initial folow up for a year they say there are new reports coming that aneurysms are more likley to rupture when they are first formed and sometimes later on can go under some healing process that the walls get stronger. I panic so much over these aneurysms, I have stopped smoking and they have put me on enalapril 5mg for proper blood pressure maintanence. I am 31 years old female and I am so stressed as I have a family history of aneurysm rupture. Do you think I should go under endovascular treatment directly or is this follow up and checking over time is necessary? Thank you

[Dr. Kokil Mathur]

Hi vennus!
I can understand your stress, but the question is very difficult to answer. Your headaches could be due to high blood pressure. So if pressure is under control, and as you have wisely given up smoking, the harmful effect of high BP and nicotine are no longer there. Aneurysms are often incidental findings, and usually require no treatment unless a symptom develops or annual check-ups reveal the need due to size enlarging, walls thinning or pressure symptoms.
However, since you have a family history of aneurysms bursting, a more careful watch needs to be maintained. All brain surgeries, however small can be risky. Hence the neurologist has to weight the pros and cons of surgery versus watching the aneurysm. You could take a second opinion from another neurologist in your area, so that you remain less anxious. Take care!

[vennus]

Dear Dr.

Thank you very much for your fast response. I finally decided on endovascular coilling and will be having it done early next year. I have asked opinion of brain surgeons and they all reffered me to neuroradiologists since the aneurysm can not be treated surgically. And of all the neuroradiologists I have spoken so far had the same idea not to wait but treat. They give 95% success rate and I hope everything will go fine.