Surgical management of the unruptured cerebral aneurysm accompanied by ischemic cerebrovascular disease.

Unruptured cerebral aneurysms accompanied by ischemic CVD in 16 patients were analyzed and their managements are discussed. Unruptured aneurysms of 8 patients with mild or no clinical symptoms and small low density areas on CT were treated surgically. There was no operative mortality, but postoperative complication occurred in two patients. Both were operated on through the ipsilateral side of ischemic lesions shortly after the onset of ischemic symptoms. Eight patients who had severe neurological deficits due to ischemic lesions and large low density areas on CT did not receive aneurysmal operation. When unruptured aneurysms are accompanied by ischemic CVD, the treatment should be determined by the severity of neurological deficits caused by ischemic CVD. If an unruptured aneurysm was the source of emboli resulting in the ischemic lesion, it should be operated. Careful manipulation is required during surgery, especially from the ipsilateral side of ischemic lesion.