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This is a Literature Review study.

September 21, 2025Open Access

Management of Intracranial Perforator Aneurysms

KPKarthik PapisettyUniversity of Minnesota SSShayli SchulzUniversity of Minnesota RDRajiv DharnipragadaJohns Hopkins Hospital

Key Points

Intracranial perforator aneurysms pose serious risks, potentially causing subarachnoid hemorrhage, and require a proactive approach for detection.
Substantial awareness is necessary due to frequent negative initial imaging in patients with perforator aneurysms, indicating the need for suspicion.
Comprehensive management strategies available include conservative care, endovascular treatment, and microsurgical clipping, each aiding in treatment success.
The study underscores the importance of recognizing perforator aneurysms as significant contributors to subarachnoid hemorrhage, which are often overlooked.

Abstract

Intracranial perforator aneurysms are rare but potentially life‐threatening vascular lesions that can lead to subarachnoid hemorrhage. Initial imaging is frequently negative, so a high level of suspicion is important for efficient detection of perforator aneurysms. The management of these lesions is challenging due to their location and delicate surrounding structures. Conservative management, endovascular treatment, and microsurgical clipping have been used to manage perforator aneurysms successfully. Because perforator aneurysms remain an underappreciated source of subarachnoid hemorrhage even when initial vascular imaging is negative, we aim to review this topic to raise awareness and the level of suspicion and provide an overview of treatment options for these challenging vascular lesions.

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