Clinical outcomes of multiple aneurysms microsurgical clipping: Evaluation of 90 patients

The incidence of multiple intracranial aneurysms (MIAs) among patients who are diagnosed with aneurysm is 15-45% in the literature. Treatment options depend on the patient's status, age, aneurysm location and neurosurgeon's experience. In this study outcomes of micro-surgically clipped 90 patients have been evaluated.

Medical records of 90 (49 women and 41 men) patients of MIAs who underwent surgery by the authors, during a 3-year period from 2011 to 2013 were retrospectively reviewed of prospectively collected patients' data. Surgically treated patients underwent a lateral supraorbital craniotomy followed by microsurgical clipping of all reachable aneurysms.

The mean age of the sample is 50.8±11.9 (25-82) years. There were 67 patients presented with SAH. The most common complaint was severe headache of sudden onset (94%) in SAH group and migraine type headache (60.8%) in incidentally diagnosed group. According to location of the arteries; ACoA (50), MCA (R:49,L:45), ICA (R:34,L:15), PCoA (R:9,L:4), ACA (R:6,L:4), basilar artery (3) and SCA (2). Mortality rate was 13.3% (n=12), morbidity rate (new deficit was developed) was 18.8% (n=17) [7 out of them were partially/completely dependent on others for daily living activities before surgery (i.e. GOS<3)] and 67.8% (n=61) of the patients returned to their normal jobs and daily activities.

Multiple cerebral aneurysms are not associated with a less favorable outcome than are single aneurysm cases. Authors prefer microsurgical clipping of all the aneurysms, be it on the reverse side, if the aneurysm location is reachable and that includes bilaterally presenting MIAs.