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[Surgical strategy and outcome in multiple cerebral aneurysms]
Ryszard Czepko1, Mariusz Rybak, Paweł Potoczny
1Klinika Neurochirurgii Collegium Medicum, Uniwersytetu Jagiellońskeigo, Kraków. rczepko@poczta.onet.pl
Przeglad Lekarski
|November 2, 2004
Summary
Surgically treating multiple brain aneurysms yields outcomes similar to single aneurysms, with good preoperative condition and younger age being positive prognostic factors. However, perioperative risks are slightly higher in multiple aneurysm cases.
Area of Science:
- Neurosurgery
- Cerebrovascular Surgery
- Neurosurgical Outcomes
Background:
- Multiple brain aneurysms pose greater risks than single aneurysms, with co-existing "silent" aneurysms carrying a significant rebleeding danger.
- Subarachnoid hemorrhage (SAH) risk from untreated "silent" aneurysms is approximately 2% annually, necessitating surgical consideration.
- The presence of multiple aneurysms increases the overall danger and complexity of treatment compared to single aneurysms.
Purpose of the Study:
- To evaluate the surgical outcomes for patients with multiple aneurysms causing subarachnoid hemorrhage (SAH).
- To identify specific risk factors influencing surgical success in cases of multiple cerebral aneurysms.
- To compare the outcomes of multiple aneurysms with those of single aneurysms.
Main Methods:
- Retrospective analysis of 608 patients treated for cerebral aneurysms between 2001-2003.
- 14% of patients presented with multiple aneurysms (two or more).
- Surgical outcomes (Glasgow Outcome Scale) were analyzed based on preoperative condition, age, aneurysm location, and timing of surgery, with preoperative diagnostic accuracy also assessed.
Main Results:
- Out of 85 patients with multiple aneurysms, 75.3% had very good or good outcomes at discharge.
- Factors indicating a good prognosis included favorable preoperative condition, age under 55, and middle cerebral artery aneurysms.
- While overall outcomes were similar to single aneurysms, perioperative losses were 5% higher in the multiple aneurysm group.
Conclusions:
- Surgical outcomes for multiple cerebral aneurysms are comparable to single aneurysms, with specific patient and aneurysm characteristics influencing prognosis.
- Good preoperative status, younger age (<55), and middle cerebral artery aneurysm location are favorable prognostic indicators.
- Accurate preoperative detection of the "bleeding" aneurysm was achieved in all cases within this study series.