Summary
We review the surgical results in 372 cases of multiple intracranial aneurysms over a 25-year period in which one of us (JS) performed 2,000 direct operations for aneurysms. All patients were classified into four groups according to the location of the aneurysm: Group 1: multiple aneurysms including anterior communicating artery aneurysm (157 cases); Group 2: multiple aneurysms of unilateral anterior circulation (72 cases); Group 3: multiple aneurysms of bilateral anterior circulation (110 cases); Group 4: multiple aneurysms including vertebro-basilar artery aneurysms (33 cases).
In multiple aneurysm cases, our policy has been to treat all aneurysms, ruptured and unruptured, in a one-stage operation whenever possible. About 90% of patients in both Group 1 and 2 were treated by one-stage operations, while 60% of patients in Group 3 and 42% of patients in Group 4 were operated on in the same manner.
Excellent and good results in from 73% to 81% of cases were obtained in patients in Group 1, Group 2 and Group 3. Morbidity was 14–19% and mortality was 6–8%. These results were comparable to the results with a single aneurysm of the anterior circulation. On the other hand, the surgical results in Group 4 were poor with a mortality of 27%. Poor results were attributable to the postoperative rebleeding from the untreated vertebro-basilar aneurysms, which were thought to be unruptured aneurysms preoperatively.
Furthermore, it was clarified that the results of early one-stage operations (within one week from onset) in patients with multiple aneurysms were satisfactory. In this group, there was good recovery in 84% of patients, 7% were disabled and 9% died. The morbidity was notably lower in patients operated on within one week than in those operated on after 8 days. Based on these results, the one-stage operation in the acute period is recommended for patients with multiple aneurysms.
Similar content being viewed by others
References
Almaani WS, Richardson AE (1978) Multiple intracranial aneurysms: identifying the ruptured lesion. Surg Neurol 9: 303–305
Drake CG, Grivin JP (1976) The surgical treatment of subarachnoid hemorrhage with multiple aneurysms. In: Morley TP (ed) Current controversies in neurosurgery. WB Saunders, Philadelphia, pp 274–278
Heiskanen O (1965) The identification of ruptured aneurysm in patients with multiple intracranial aneurysms. Neurochirurgia (Stuttg) 8: 102–107
Heiskanen O (1981) Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55: 524–526
Heiskanen O (1986) Risks of surgery for unruptured intracranial aneurysms. J Neurosurg 65: 451–453
Hunt WE, Kosnik EJ (1974) Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21: 79–89
Marttila I, Heiskanen O (1970) Value of neurological and angiographic signs as indicators of the ruptured aneurysm in patients with multiple intracranial aneurysms. Acta Neurochir (Wien) 23: 95–102
McKissock W, Richardson A, Walsh L (1964) Multiple intracranial aneurysms. Lancet 1: 623–626
Mizoi K, Suzuki J, Kinjo Tet al (1988) Bifrontal interhemispheric approach for carotid-ophthalmic aneurysms. Acta Neurochir (Wien) 90: 84–90
Modesti LM, Binet EF (1978) Value of computed tomography in the diagnosis and management of subarachnoid hemorrhage. Neurosurgery 3: 151–156
Nehls DG, Flom RA, Carter LPet al (1985) Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63: 342–348
Paterson A, Bond MR (1973) Treatment of multiple intracranial arterial aneurysms. Lancet 1: 1302–1304
Sakamoto T, Kwak R, Mizoi Ket al (1979) Angiographical study of the ruptured aneurysm in multiple aneurysm patients. In: Suzuki J (ed) Cerebral aneurysms. Neuron Co., Tokyo, pp 171–175
Salazar JL (1980) Surgical treatment of asymptomatic and incidental aneurysms. J Neurosurg 53: 20–21
Samson DS, Hodosh RM, Clark WK (1977) Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46: 731–734
Suzuki J, Sakurai Y (1979) The treatment of intracranial multiple aneurysms. In: Suzuki J (ed) Cerebral aneurysms. Neuron Co., Tokyo, pp 293–307
Suzuki J, Onuma T, Yoshimoto T (1979) Results of early operation on cerebral aneurysms. Surg Neurol 11: 407–412
Suzuki J, Yoshimoto T (1979) The effect of mannitol in prolongation of permissible occlusion time of cerebral artery-clinical data of aneurysm surgery. Neurosurg Rev 1: 13–19
Suzuki J, Yoshimoto T, Kayama T (1984) Surgical treatment of middle cerebral artery aneurysms. J Neurosurg 61: 17–23
Suzuki J, Fujimoto S, Mizoi Ket al (1984) The protective effect of combined administration of antioxidants and perfluorochemicals on cerebral ischemia. Stroke 15: 672–679
Suzuki J, Mizoi K, Yoshimoto T (1986) Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg 64: 183–190
Suzuki J, Abiko H, Mizoi Ket al (1987) Protective effect of phenytoin and its enhanced action by combined administration with mannitol and vitamin E in cerebral ischemia. Acta Neurochir (Wien) 88: 56–64
Vajda J, Juhàse J, Orosz Eet al (1986) Surgical treatment of multiple aneurysms. Acta Neurochir (Wien) 82: 14–23
Weisberg LA (1979) Computed tomography in aneurysmal subarachnoid hemorrhage. Neurology 29: 802–808
Winn HR, Almaani WS, Berga SLet al (1983) The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59: 642–651
Wood EH (1964) Angiographic identification of the ruptured lesion in patients with multiple cerebral aneurysms. J Neurosurg 21: 182–198
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mizoi, K., Suzuki, J. & Yoshimoto, T. Surgical treatment of multiple aneurysms. Acta neurochir 96, 8–14 (1989). https://doi.org/10.1007/BF01403489
Issue Date:
DOI: https://doi.org/10.1007/BF01403489