Risks of surgery for unruptured intracranial aneurysms

Area of Science:

• Neurosurgery
• Vascular Neurology
• Critical Care Medicine

Background:

• Multiple intracranial aneurysms pose a significant risk of subarachnoid hemorrhage.
• Subsequent bleeding from untreated aneurysms can lead to severe neurological deficits or death.

Purpose of the Study:

• To evaluate the safety and efficacy of a second surgical intervention for clipping all aneurysms in patients presenting with subarachnoid hemorrhage.
• To compare surgical risks with the natural risks of aneurysm re-bleeding.

Main Methods:

• A retrospective review of 43 patients with multiple aneurysms and subarachnoid hemorrhage requiring a second surgical procedure.
• Analysis of surgical mortality and morbidity, including neurological deficits and procedure-related complications.

Main Results:

• One surgical death occurred (2.3% mortality rate) due to coronary thrombosis and infarction three weeks post-surgery.
• One patient experienced a permanent neurological deficit (hemiparesis and dysphasia).
• Surgical risks were found to be lower than the natural risk of re-bleeding and death.

Conclusions:

• A second surgical clipping is indicated for low-risk patients with multiple or incidentally discovered aneurysms.
• The benefits of surgical intervention outweigh the risks, especially when compared to the natural history of untreated aneurysms.
• Patients with significant comorbidities increasing surgical risk should be carefully evaluated before considering elective aneurysm clipping.