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Ruptured and Unruptured Intracranial Aneurysms – Surgical Outcome

Published online by Cambridge University Press:  18 September 2015

Gary A. Dix ,
William Gordon ,
Anthony M. Kaufmann ,
Ian S. Sutherland  and
Garnette R. Sutherland
Gary A. Dix
Affiliation:
Department of Clinical Neurosciences (Neurosurgery), The University of Calgary, Calgary
William Gordon
Affiliation:
Department of Radiology (Neuroradiology), The University of Manitoba, Winnipeg
Anthony M. Kaufmann
Affiliation:
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Ian S. Sutherland
Affiliation:
Department of Radiology (Neuroradiology), The University of Manitoba, Winnipeg
Garnette R. Sutherland*
Affiliation:
Department of Clinical Neurosciences (Neurosurgery), The University of Calgary, Calgary
*
Department of Clinical Neurosciences, Foothills Hospital, 1403 – 29 Street N.W., Calgary, Alberta, Canada T2N 2T9
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Abstract

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Background

The treatment of unruptured, intracranial aneurysms has been the topic of debate. Although recent studies have advocated surgical intervention for unruptured aneurysms, the risk of such treatment in comparison to outcome from ruptured aneurysms has not been established.

Method

This retrospective study examines the outcome of 134 patients with 179 ruptured and unruptured intracranial, saccular aneurysms treated by a single surgeon.

Results

Of the 98 ruptured aneurysms where early surgical intervention was undertaken (less than 48 hours post hemorrhage), 70 had an excellent outcome, 13 were good, four were moderate, two poor and nine patients died postoperatively. Outcome assessment in these cases was correlated to preoperative neurological status. Patients who presented with unruptured aneurysms fell into two categories: symptomatic and asymptomatic. Seven incidental, asymptomatic aneurysms were clipped concurrently to the surgical isolation of the culprit lesion following subarachnoid hemorrhage without influencing outcome, whilst, for varying reasons, eight unruptured aneurysms were not operated upon. Of the remaining 66 surgically treated, unruptured aneurysms, 64 had an excellent postoperative result, one was good (persisting right incomplete third nerve palsy) and one was moderate (left hemiparesis). Thirteen of these aneurysms were symptomatic, whilst 21 were asymptomatic, multiple aneurysms requiring secondary elective repair and 32 were true incidental aneurysms.

Conclusion

Unruptured aneurysms less than 25 mm in size may be safely, surgically treated relative to the expected natural history and, certainly, with less risk than operative intervention upon ruptured cerebral aneurysms.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 22 , Issue 3 , August 1995 , pp. 187 - 191
Copyright
Copyright © Canadian Neurological Sciences Federation 1995

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