OBJECTIVEAlthough direct clipping remains the treatment of choice for intracranial aneurysms, not all aneurysms can be clipped. This report reviews the results of bipolar coagulation followed by parent vessel reinforcement for the treatment of intracranial microaneurysms (maximal diameter of ≤3 mm), with immediate and delayed postoperative angiographic evaluation in all cases.METHODSDuring a 1-year period, 20 intracranial microaneurysms in 12 patients were treated with bipolar electrocoagulation followed by reinforcement of the parent artery with muslin gauze. All patients underwent intraoperative or immediate postoperative angiographic evaluation, and all underwent follow-up angiographic evaluation approximately 1 year later. No patient was lost to follow-up monitoring.RESULTSMicroaneurysms involved the middle cerebral artery (eight cases), internal carotid artery (six cases), anterior cerebral/anterior communicating artery (five cases), and superior cerebellar artery (one case). In all cases, the patient was undergoing a craniotomy for clipping of a larger aneurysm, and the microaneurysms were treated concurrently. At the time of the immediate angiographic examinations, 19 of 20 (95%) microaneurysms were no longer visible and 1 was substantially smaller (<1-mm irregularity on the parent vessel). No patient experienced an adverse event related to microaneurysm treatment. In the 1-year follow-up examinations, there was no angiographic evidence of recurrence in the 19 cases with complete obliteration; the one residual aneurysm remained stable.CONCLUSIONAt 1 year, direct coagulation followed by parent vessel reinforcement seems to provide a satisfactory treatment option for intracranial microaneurysms.