Surgical treatment of multiple intracranial aneurysms

Abstract

Patients with multiple intracranial aneurysms present a great challenge to neurosurgical practice. The presence of one or more additional aneurysms, whether recognized or unrecognized, along with the source of the haemorrhage profoundly changes the outcome. It also alters the timing and strategy of surgery. In this study the experiences gained from 138 cases with a total of 317 aneurysms are discussed. The analysis of the clinical data, our results and the factors influencing the outcome suggest that the risk of clipping all aneurysms simultaneously are less than the risk of a rebleed from an untreated, previously silent sac even in the early postoperative period.

Surgical outcome for multiple intracranial aneurysms

“…There was a higher incidence of multiple aneurysms in woman (62.9%) and this finding agrees with most of the previous studies [1,13,17,23,24,31,33,34].…”

“…However, this was contrary to that of Vajda et al [34,35] and Rinne et al [29], who stated that multiple intracranial aneurysms increase the risk for a poor outcome. The only significant difference in the overall outcome between multiple and single aneurysms cases was that in cases presenting without SAH (unruptured aneurysms), especially in the excellent or good outcome group (94.9%) in single aneurysm cases and (86.5%) in multiple cases, this may be attributed to the increased manipulation of cerebral arteries and brain tissue while treating multiple aneurysms [29].…”

“…The incidence of diagnosed multiple intracranial aneurysms ranges from 5% and 33.5%, depending primarily on the completeness of the diagnostic procedures [12,13,17,18,23,24,28,30,31,33,34]. The significance of establishing the presence of further aneurysms is that there is a higher associated mortality and morbidity in patients with multiple lesions [10,26].…”

Multiple intracranial aneurysms: Surgical treatment and outcome

“…In the past decade the surgeon's aim has been a single operation that would allow him to treat both symptomatic and asymptomatic lesions 2,6,[19][20]. When this has not been feasible, the practice has been to deal first with the symptomatic aneurysms and later with the asymptomatic lesions 3.…”

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“…Em nossa casuística, 24 dos 29 casos eram do sexo feminino (da mesma forma, na literatura, há predomínio do sexo feminino nos casos de aneurismas intracranianos múltiplos), 4,7,17 a faixa etária esteve entre 40 e 60 anos (na literatura, é o grupo etário com maior incidência de hemorragia subaracnóidea aneurismática) 4,7 e, assim como em todos os estudos revisados, 7,8,10,11,[15][16][17][18][19][20] a ruptura aneurismática foi a forma de apresentação mais comum (25 casos dos 29 pacientes), tornando a identificação pré-operatória do aneurisma roto condição sine qua non para a decisão e planejamento da estratégia terapêutica. A identificação do sítio de ruptura aneurismática foi realizada por meio de um algoritmo elaborado por Nehls et al, 18 em 1985, com base em informações obtidas da tomografia de crânio, da angiografia cerebral e do exame clínico de pacientes com aneurismas intracranianos múltiplos.…”