Management of Intracranial Perforator Aneurysms

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.