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Multiple intracranial aneurysms: a high risk condition.

¹National Institute of Neurosurgery, Budapest, Hungary.

Acta Neurochirurgica

|January 1, 1992

Summary

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Treating multiple brain aneurysms can be complex due to risks like bleeding and missed lesions. Complete one-stage surgical repair is advocated, proving safer than the natural progression of untreated multiple aneurysms.

Area of Science:

Neurosurgery
Vascular Neurology

Background:

Management strategies for multiple intracranial aneurysms remain debated.
Existing literature lacks clear guidelines for optimal treatment policy.

Observation:

Multiple aneurysms present unique challenges, including peri-operative bleeding risk from asymptomatic lesions.
Angiographic visualization can miss aneurysms, complicating diagnosis and treatment planning.
Misidentification of ruptured vs. incidental aneurysms can lead to delayed or staged interventions.

Findings:

A study of 330 multiple aneurysm operations supports one-stage complete repair.
Bilateral pterional craniotomies or contralateral approaches facilitate comprehensive treatment.
Selective delayed clipping of certain asymptomatic aneurysms is also described as a safe option.

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Implications:

Aggressive, one-stage surgical intervention for multiple aneurysms is associated with lower risks than natural disease progression.
This approach may reduce the likelihood of future rupture and associated morbidity/mortality.
Evidence supports a shift towards more definitive, single-session management of multiple intracranial aneurysms.