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Surgical outcome for multiple intracranial aneurysms

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Summary

The surgical outcome of 221 cases with multiple intracranial aneurysms operated upon during the years 1988 to 1994 were reviewed. The patients were classified into three groups according to the locations of the aneurysms; group 1: multiple aneurysms located unilaterally in the anterior circulation only (147 cases); group 2: multiple aneurysms located bilaterally in the anterior circulation only (44 cases) and group 3: multiple aneurysms located in both anterior and posterior circulation or in the posterior circulation alone (30 cases). In 132 cases of group 1 (89.8%) all aneurysms were treated in one-stage operations. Twenty-eight patients from group 2 (63.6%) received partial treatment, where only the ruptured or the symptomatic aneurysms were treated. In 12 other cases from group 2 (27.3%) all multiple aneurysms were treated in two-stage operations. In group 3 patients, one-stage operations were performed in 18 cases (60%), while 9 patients (30%) received partial treatment only. Of the 221 multiple aneurysm cases, 162 (73.3%) presented with manifestations of subarachnoid haemorrhage (SAH). The remaining 59 multiple aneurysms cases (26.7%) presented with manifestations other than SAH (unruptured aneurysms). In the postoperative follow-up, of the 221 multiple aneurysms cases, 113 (51.1%) were free of neurological deficit (excellent), 48 cases (21.7%) were capable of leading an independent life (good), 32 cases (14.5%) were not independent and needed to be assisted (fair), and 28 patients (12.7%) died. These results were comparable to the results of patients with single aneurysms operated on during the same period.

Based on our results, we recommend that whenever possible all multiple aneurysms should be treated in one-stage operations. In unruptured multiple aneurysm cases surgical management is the recommended treatment. In poor grade SAH patients or unruptured multiple aneurysms in old patients, two-stage operations or partial treatment of only the ruptured or the symptomatic aneurysms may be adopted.

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References

  1. Andrews RJ, Speigel PK (1979) Intracranial aneurysms: age, sex, blood pressure, and multiplicity in an unselected series of patients. J Neurosurg 51: 27–32

    PubMed  Google Scholar 

  2. Brisman R (1985) Management of multiple and asymptomatic aneurysms. In: Fein JM, Flamm ES (eds) Cerebrovascular surgery, Vol 3. Springer, Berlin Heidelberg New York Tokyo, pp 983–995

    Google Scholar 

  3. Brusse O (1921) Aneurysmen und Bildungsfehler der Arteria communicans anterior. Virchows Arch 229: 178–206

    Google Scholar 

  4. Drake CG, Girvin JP (1976) The surgical treatment of sub-arachnoid hemorrhage with multiple aneurysms. In: Morley TP (ed) Current controversies in neurosurgery. Saunders, Philadelphia, pp 274–278

    Google Scholar 

  5. Fogelholm R, Hernesniemi J, Vapalahti M (1993) Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage: a population-based study. Stroke 24: 1649–1654

    PubMed  Google Scholar 

  6. Graf CJ, Nibbelink DW (1974) Cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Stroke 5: 559–601

    Google Scholar 

  7. Heiskanen O (1981) Risk of bleeding from the unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55: 524–526

    PubMed  Google Scholar 

  8. Heiskanan O (1986) Risks of surgery for unruptured intracranial aneurysms. J Neurosurg 56: 451–453

    Google Scholar 

  9. Heiskanan O, Marrtila I (1970) Risk of rupture of a second aneurysm in patients with multiple aneurysms. J Neurosurg 32: 295–299

    PubMed  Google Scholar 

  10. Heiskanan O (1965) Multiple intracranial arterial aneurysms. Acta Neurol Scand 41: 356–362

    Google Scholar 

  11. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20

    PubMed  Google Scholar 

  12. Inagawa T (1990) Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 106: 119–126

    Google Scholar 

  13. Inagawa T, Hirano A (1990) Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 34: 361–365

    PubMed  Google Scholar 

  14. Inagawa T (1991) Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien) 108: 22–29

    Google Scholar 

  15. Jane JA, Winn RH, Richardson AE (1977) The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 24: 176–184

    PubMed  Google Scholar 

  16. Kassell NF, Torner JC (1983) Size of intracranial aneurysms. Neurosurgery 12: 291–297

    PubMed  Google Scholar 

  17. McKissock W, Richardson A, Walsh L (1964) Multiple intracranial aneurysms. Lancet 1: 623–626

    Google Scholar 

  18. Mizoi K, Suzuki J, Yoshimoto T (1989) Surgical treatment of multiple aneurysms: review of experience with 372 cases. Acta Neurochir (Wien) 96: 8–14

    Google Scholar 

  19. Mount LA, Brisman R (1971) Treatment of multiple intracranial aneurysms. J Neurosurg 35: 728–730

    PubMed  Google Scholar 

  20. Mount LA, Brisman R (1977) Treatment of multiple and asymptomatic aneurysms. In: Schmidek HH, Sweet WH (eds) Current techniques in operative neurosurgery. Grune and Stratton, New York, pp 19–23

    Google Scholar 

  21. Mount LA, Brisman R (1974) Treatment of multiple aneurysms: symptomatic and asymptomatic. Clin Neurosurg 21: 166–170

    PubMed  Google Scholar 

  22. Moyes PD (1971) Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 35: 291–295

    Google Scholar 

  23. Nehls DG, Flom RA, Carter LP, Spetzler RF (1985) Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63: 342–348

    PubMed  Google Scholar 

  24. Østergaard JR, Hog E (1985) Incidence of multiple intracranial aneurysms: influence of arterial hypertension and gender. J Neurosurg 63: 49–55

    PubMed  Google Scholar 

  25. de Oliveira E, Tedeschi H, Siqueira MG, Ono M, Fretes C, Rhoton AL Jr, Peace DA (1996) Anatomical and technical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir (Wien) 138: 1–11

    Google Scholar 

  26. Pakarinen S (1967) Incidence, aetiology and prognosis of primary subarachnoid hemorrhage; a study based on 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand 43 [Suppl 29]: 1–128

    Google Scholar 

  27. Paterson A, Bond MR (1973) Treatment of multiple intracranial arterial aneurysms. Lancet 1: 1302–1304

    PubMed  Google Scholar 

  28. Pool JL, Potts DG (1965) Aneurysms and arteriovenous anomalies of the brain. Harper and Row, New York, pp 287–288

    Google Scholar 

  29. Poppen JL, Fager CA (1959) Multiple intracranial aneurysms. J Neurosurg 16: 581–589

    PubMed  Google Scholar 

  30. Rinne J, Hernesniemi J, Niskanen M, Valapahti M (1995) Management outcome for multiple intracranial aneurysms. Neurosurgery 36: 31–37

    PubMed  Google Scholar 

  31. Salazar JL (1980) Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 53: 20–21

    PubMed  Google Scholar 

  32. Salazar JL (1983) Analysis of 220 aneurysms: medical and surgical treatment of ruptured and unruptured intracranial aneurysms. Illinois Med J 164: 477–484

    Google Scholar 

  33. Samson DS, Hodosh RM, Clark WK (1977) Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46: 731–734

    PubMed  Google Scholar 

  34. Suzuki J, Sakurai Y (1979) The surgical treatment of intracranial multiple aneurysms. In: Suzuki (ed) Cerebral aneurysms. Tokyo, Neuron, pp 293–307

    Google Scholar 

  35. Vajda J, Juhasz J, Orosz E, Pasztor E, Toth SZ, Horvath M (1986) Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien) 82: 14–23

    Google Scholar 

  36. Vajda J (1992) Multiple intracranial aneurysms: a high risk condition. Acta Neurochir (Wien) 118: 59–75

    Google Scholar 

  37. Winn RH, Richardson AE, Jane JA (1977) The long-term prognosis in untreated cerebral aneurysms: 1. The incidence of late haemorrhage in cerebral aneurysm: a 10-year evaluation of 364 patients. Ann Neurol 1: 358–370

    PubMed  Google Scholar 

  38. Winn HR, Almaani WS, Berga SL, Jane JA, Richardson AE (1983) The long-term outcome in patients with multiple aneurysms: incidence of the late haemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59: 642–651

    PubMed  Google Scholar 

  39. Wirth FP, Iaws ER, Piepgras D, Scott RM (1983) Surgical treatment of incidental intracranial aneurysms. Neurosurgery 12: 507–511

    PubMed  Google Scholar 

  40. Yasargil MG (1984) Multiple aneurysms. In: Microneurosurgery, Vol 1. Thieme, Stuttgart, pp 305–328

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Shinshu University School Medicine, Matsumoto, Japan

    Y. Orz, M. Osawa, Y. Tanaka, K. Kyoshima & S. Kobayashi

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  1. Y. Orz
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  2. M. Osawa
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  3. Y. Tanaka
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  4. K. Kyoshima
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  5. S. Kobayashi
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Orz, Y., Osawa, M., Tanaka, Y. et al. Surgical outcome for multiple intracranial aneurysms. Acta neurochir 138, 411–417 (1996). https://doi.org/10.1007/BF01420303

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