[Surgical strategy in cases of multiple aneurysms].

Over a 4 year period 50 patients (34 women, 16 men; median age 48.5 years, range 24-69 ys.) were operated on multiple intracranial aneurysms (MA) and 283 patients (178 women, 105 men, median age 50.0 years; range 22-82 ys.) on single aneurysms (SA). A subarachnoid hemorrhage (SAH) occurred in the MA-group (in total 123 aneurysms, 5 giant aneurysms) in 43 cases, in the SA-group in 257 cases. Fifty-seven percent of all patients were operated on within 48 hours after SAH, 14% between day 3 and 7, 29% after day 7. There were no significant differences in the Hunt & Hess grading or in the distribution of ruptured aneurysms between both groups. Operation time was longer by 70 min in MA-patients than in SA-patients, but did not significantly influence the outcome in that group (rs = 0.200; p = 0.163). In 74% of the patients all aneurysms could be eliminated in one stage, among them 18 had bilateral or supra-infratentorial aneurysms. The step by step occlusion of the aneurysms was performed by dissecting all aneurysms and by clipping the deepest one and the bleeding source first. In 8 cases, all aneurysms were clipped through a contralateral keyhole approach.--After a mean follow up period of 1 year, 72% of the MA-patients and 65% of the SA-patients had made an excellent or good recovery. The morbidity rate was 22% in the MA- and 30% in the SA-patients. The operative mortality amounted to 6% in the MA- and 5% in the SA-group. The differences in outcome of both groups were not significant. Considering a bleeding risk of 1-2% per year, we suggest the operative treatment of all identified aneurysms, if possible in a one-stage, if necessary in a two-stage procedure in an individually tailored approach.