American Board of Internal Medicine (ABIM) Certification Practice Exam

What primary indication leads to surgical treatment in patients with anterior circulation intracranial aneurysms?

1. Aneurysms greater than 5 mm

2. Aneurysms greater than 10 mm

3. Aneurysms greater than 12 mm

4. Aneurysms less than 7 mm

The correct answer is: Aneurysms greater than 12 mm

Surgical treatment for anterior circulation intracranial aneurysms is primarily indicated for larger aneurysms due to the increased risk of rupture and subsequent subarachnoid hemorrhage. Aneurysms that are greater than 10 mm, particularly those exceeding 12 mm, pose a significant risk of complications and generally warrant proactive surgical intervention. The rationale is that larger aneurysms have a higher incidence of rupture, which can lead to devastating health outcomes. While aneurysms greater than 5 mm do raise concern, the threshold of 12 mm is often considered a critical point where the benefits of surgical intervention outweigh the risks. Thus, this cut-off reflects current clinical practice guidelines and the consensus of expert opinion that prioritize patient safety and long-term outcomes. In contrast, smaller aneurysms, such as those less than 7 mm, usually undergo careful monitoring rather than immediate surgical treatment, as their risk of rupture is relatively lower. Thus, the primary indication leading to surgical treatment specifically correlates with the size threshold that indicates a significantly higher rupturing potential.