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Background:Tiny false intracranial rupture aneurysms are particularly rare. It is challenged both to neurosurgery and endovascular treatment.Methods:We present here five rare cases of perforator tiny aneurysms that were diagnosed based on DSA. These patients were found due to SAH, and they decided to treat these aneurysms with endovascular therapy. After numerous attempts, the coiling microcatheter failed to access the aneurysms. As a result, the aneurysms finally were treated with guidewire manipulation.Results:Mean follow-up time was about 10.4 months. The outcomes of the 5 cases were all surprisingly excel ent. The patients were followed up with angiography and telephone till now. No revascularization of aneurysm was found.Conclusions:This paper demonstrated for the first time to our knowledge that tiny false intracranial aneurysm may be treated with guidewire manipulation. While larger studies with long-term follow-up are required to validate these promising results, guidewire manipulation is a new approach worth considering when microcatheter cannot enter aneurysm.