Surgical Management of Multiple Intracranial Aneurysms

Objective To explore the methods to diagnose and treat multiple intracranial aneurysms. Methods Clinical data of 21 patients with multiple intracranial aneurysms, in whom 43 aneurysms were found, were analyzed retrospectively. There were 2 aneurysms in each of 20 patients, and 3 aneurysms were found in 1 patients. Of 18 patients undergoing the surgery, 16 were treated by one-stage operation though unilateral approach and 2 by two-stages operations through bilateral approach in 2 cases. The bilateral posterior communicating artery aneurysms were clipped via unilateral keyhole approach in 3 patients. One side routine pterional craniotomy was performed in 13 patients, of whom, 1 underwent an operation clipping 3 aneurysms, 8 underwent an operation clipping 2 aneurysms, 2 underwent an operation clipping and wrapping 2 aneurysms and 2 underwent an operation clipping 1 aneurysms. Four aneurysms were endovascularly embolized in 2 patients. However, one patient with unruptured aneurysms was discharged from hospital due to reluctance to treat. Results Twenty patients receiving the surgical or endovascular treatment were survived. Of 16 patients followed up from 4 months to 6 years, 11 returned to normal life or work, 2 had hemiparesis, 1 was severely disabled, 1 vegetably survived and 1 patient with bilateral posterior communicating artery aneurysms in whom an aneurysm contralateral to the operation was not treated due to surgical difficulties, and who refused second craniotomy in spite of relatively good recovery after the first surgical treatment, sudden lost self-consciousness and died 10 months after the dischange from hospital. Conclusions The patients with multiple intracranial aneurysms should be early surgically treated. It is possible to treat all the intracranial aneurysms by an operation through unilateral approach in most of the patients with bilateral or multi-position aneurysms.