[Surgical strategy and outcome in multiple cerebral aneurysms].

INTRODUCTION

Multiple aneurysms of the brain are a more dangerous disorder than single aneurysms. Most of patients have evidence of aneurysmal rupture, but rebleeding remains an additional danger because of co-existing aneurysms. These "silent" aneurysms also have to be operated--the risk of following subarachnoid haemorrhage (SAH) is about 2% annually.

AIM

The purpose of this study was to assess of the surgical outcome in multiple aneurysmal SAH in regard to chosen risk factors.

MATERIAL AND METHOD

Retrospective analysis of 608 patients treated within three years (2001-2003) for cerebral aneurysms in the Department of Neurosurgery, Jagiellonian University in Kraków, was carried out. 14% patients had multiple aneurysms: 72--two aneurysms, 10 patients three aneurysms, and three patients four and more. The mean age was 50, with slight predominance of women (58%). Most patients were operated on via pterional craniotomy, and posterior circulation aneurysms were clipped by means of suboccipital approach. "Silent" aneurysms being clipped in the first stage, if were available via the same craniotomy, another--in the next stage. We analyzed short-term outcome of multiple aneurysms in comparison to the single (literature data). We presented the outcome (according to the Glasgow Outcome Scale) with regard to preoperative condition, age, location of the most frequent "bleeding" aneurysms (middle cerebral artery, anterior communicating artery), and in patients operated on in the 1st and 2nd stage. Accuracy of the preoperative detection of "bleeding" aneurysm was checked based on CT, MRI, angio-CT, angio-MRI and DSA.

RESULTS AND CONCLUSIONS

Out of all 85 treated patients, 64 (75.3%) presented very good and good condition on discharge. Five (5.9%) were severe disabled, and 16 (18.8%) died. Good preoperative condition, age less than 55, and "bleeding" aneurysms of the middle cerebral artery (compared with anterior communicating artery) are good prognostic factors in surgically treated multiple aneurysms. Outcome in single and multiple aneurysms is similar, excluding perioperative losses, which are 5% higher in the multiple aneurysms group. In our series in each case of "bleeding" aneurysm was correctly detected preoperatively.