Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-13T01:44:23.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Ruptured and Unruptured Intracranial Aneurysms – Surgical Outcome

Published online by Cambridge University Press:  18 September 2015

Gary A. Dix ,
William Gordon ,
Anthony M. Kaufmann ,
Ian S. Sutherland  and
Garnette R. Sutherland
Gary A. Dix
Affiliation:
Department of Clinical Neurosciences (Neurosurgery), The University of Calgary, Calgary
William Gordon
Affiliation:
Department of Radiology (Neuroradiology), The University of Manitoba, Winnipeg
Anthony M. Kaufmann
Affiliation:
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Ian S. Sutherland
Affiliation:
Department of Radiology (Neuroradiology), The University of Manitoba, Winnipeg
Garnette R. Sutherland*
Affiliation:
Department of Clinical Neurosciences (Neurosurgery), The University of Calgary, Calgary
*
Department of Clinical Neurosciences, Foothills Hospital, 1403 – 29 Street N.W., Calgary, Alberta, Canada T2N 2T9
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background

The treatment of unruptured, intracranial aneurysms has been the topic of debate. Although recent studies have advocated surgical intervention for unruptured aneurysms, the risk of such treatment in comparison to outcome from ruptured aneurysms has not been established.

Method

This retrospective study examines the outcome of 134 patients with 179 ruptured and unruptured intracranial, saccular aneurysms treated by a single surgeon.

Results

Of the 98 ruptured aneurysms where early surgical intervention was undertaken (less than 48 hours post hemorrhage), 70 had an excellent outcome, 13 were good, four were moderate, two poor and nine patients died postoperatively. Outcome assessment in these cases was correlated to preoperative neurological status. Patients who presented with unruptured aneurysms fell into two categories: symptomatic and asymptomatic. Seven incidental, asymptomatic aneurysms were clipped concurrently to the surgical isolation of the culprit lesion following subarachnoid hemorrhage without influencing outcome, whilst, for varying reasons, eight unruptured aneurysms were not operated upon. Of the remaining 66 surgically treated, unruptured aneurysms, 64 had an excellent postoperative result, one was good (persisting right incomplete third nerve palsy) and one was moderate (left hemiparesis). Thirteen of these aneurysms were symptomatic, whilst 21 were asymptomatic, multiple aneurysms requiring secondary elective repair and 32 were true incidental aneurysms.

Conclusion

Unruptured aneurysms less than 25 mm in size may be safely, surgically treated relative to the expected natural history and, certainly, with less risk than operative intervention upon ruptured cerebral aneurysms.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 22 , Issue 3 , August 1995 , pp. 187 - 191
Copyright
Copyright © Canadian Neurological Sciences Federation 1995

References

1.Allcock, JM, Canham, PB.Angiographic study of the growth of the intracranial aneurysms. J Neurosurg 1976; 45: 617–621.CrossRefGoogle ScholarPubMed
2.Deruty, R, Pelisson-Guyotat, I, et al. Surgical management of unruptured, intracranial aneurysms – personal experience with 37 cases. Acta Neurochir 1992; 119: 35–41.CrossRefGoogle ScholarPubMed
3.Kassell, NF, Tomer, JC.Size of intracranial aneurysms. Neurosurgery 1983; 12: 291–297.CrossRefGoogle ScholarPubMed
4.Kassell, NF, Drake, CG.Timing of aneurysmal surgery. Neurosurgery 1982; 10: 514–519.CrossRefGoogle Scholar
5.Kassell, NF, Torner, JC, et al. The international cooperative study on the timing of aneurysmal surgery. Part I and 2. J Neurosurg 1990; 73: 18–47.CrossRefGoogle Scholar
6.Sundt, TM Jr, Shigeaki, K, et al. Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. J Neurosurg 1982; 56: 753–765.CrossRefGoogle ScholarPubMed
7.Solomon, RA, Fink, ME, et al. Surgical management of unruptured intracranial aneurysms. J Neurosurg 1994; 80: 440–446.CrossRefGoogle ScholarPubMed
8.Winn, HR, Richardson, AE, et al. The long term prognosis in untreated cerebral aneurysms: II. Late morbidity and mortality. Ann Neurol 1978; 4: 418–426.CrossRefGoogle Scholar
9.Moyes, PD.Surgical treatment of multiple aneurysms and of incidentally-discovered, unruptured aneurysms. J Neurosurg 1971; 35: 291–295.CrossRefGoogle ScholarPubMed
10.Salazar, JL.Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 1980; 53: 20–21.CrossRefGoogle ScholarPubMed
11.Samson, DS, Hodosh, RM, et al. Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 1977; 46: 731–734.CrossRefGoogle Scholar
12.Wiebers, DO, Whisnant, JP, et al. The significance of unruptured intracranial saccular aneurysms. J Neurosurg 1987; 66: 23–29.CrossRefGoogle ScholarPubMed
13.Winn, HR, Almaani, WS, et al. The long term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 1983; 59: 642–651.CrossRefGoogle Scholar
14.Ingall, TJ, Whisnant, JP, et al. Has there been a delcine in subarachnoid hemorrhage mortality? Stroke 1989; 20: 718–724.CrossRefGoogle Scholar
15.Phillips, LH, Whisnant, JP, et al. The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 1980; 30: 1034–1040.CrossRefGoogle ScholarPubMed
16.Sundl, TM Jr, Whisnant, JP.Subarachnoid hemorrhage from intracranial aneurysms. N Engl J Med 1978; 299: 116–122.Google Scholar
17.Pakarinen, S.Incidence, etiology and prognosis of primary subarachnoid hemorrhage: a study of 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand 1967; (Suppl.) 29: 1–128.Google Scholar
18.Weir, B, Petruk, K, et al. Management mortality related to the timing of surgery for anterior circulation aneurysms. In: Auer, L.M., ed. Timing of Aneurysm Surgery. Berlin: Walter de Gruyter, 1985: 165–175.Google Scholar
19.Juvela, S, Porras, M, et al. Natural history of unruptured, intracranial aneurysms: a long term followup study. J Neurosurg 1993; 79: 174–182.CrossRefGoogle Scholar
20.Wiebers, DO, Whisnant, JP, et al. the natural history of unruptured intracranial aneurysms. N Engl J Med 1981; 304: 696–698.CrossRefGoogle ScholarPubMed
21.Crompton, MR.Mechanism of growth and rupture in cerebral berry aneurysms. Br Med J 1966; I: 1138–1142.CrossRefGoogle Scholar
22.Roger, LA.Intracranial aneurysm size and potential for rupture – correspondence. J Neurosurg 1987; 67: 475–476.Google Scholar
23.Rosenorn, J, Eskesen, V.Does a safe size-limit exist for ruptured intracranial aneurysms? Acta Neurochir 1993; 121: 113–118.CrossRefGoogle Scholar
24.Schievink, WI, Piepgras, DG, et al. Rupture of previously documented small asymptomatic saccular intracranial aneurysms – report of three cases. J Neurosurg 1992; 76: 1019–1024.CrossRefGoogle ScholarPubMed
25.Heiskanen, O, Marttila, I, et al. Risk of rupture of a second aneurysm in patients with multiple aneurysms. J Neurosurg 1970; 32: 295–300.CrossRefGoogle ScholarPubMed
26.Nakagawa, T, Hashi, K.The incidence and treatment of asymptomatic, unruptured cerebral aneurysms. J Neurosurg 1994; 80: 440–446.CrossRefGoogle ScholarPubMed