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Long-term outcome of surgically treated unruptured cerebral aneurysms
Insights
Prophylactic surgery for unruptured cerebral aneurysms is recommended for low-risk patients. Careful surgical techniques, including preserving perforator vessels and minimizing brain retraction, are crucial for good long-term outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Unruptured cerebral aneurysms pose a risk of rupture and subsequent subarachnoid hemorrhage.
- Surgical intervention for unruptured aneurysms requires careful consideration of risks and benefits.
Purpose of the Study:
- To evaluate the surgical morbidity, mortality, and long-term outcomes of patients with unruptured cerebral aneurysms.
- To identify factors influencing long-term outcomes after prophylactic aneurysm treatment.
Main Methods:
- Retrospective analysis of 69 patients with 76 unruptured cerebral aneurysms treated surgically.
- Long-term follow-up averaging 50.1 months.
- Statistical analysis to determine factors affecting outcomes.
Main Results:
- No operative mortality was observed.
- Operative morbidity occurred in 7.2% of patients (hemiplegia, memory impairment, oculomotor nerve palsy).
- Good or fair long-term outcome (average 50.1 months) was achieved in 76.8% of patients; 5-year survival rate was 94%.
Conclusions:
- Prophylactic surgery for unruptured cerebral aneurysms is associated with low morbidity and mortality in carefully selected patients.
- Preservation of perforator vessels, proper clip placement, and minimized brain retraction are essential for optimal surgical results.
- No significant factors were identified that influenced long-term morbidity in this cohort.
Abstract:
We report the surgical morbidity and mortality and the results of statistical analysis based on the long-term outcome (average 50.1 months) of 69 patients with unruptured cerebral aneurysms. These patients harbored a total of 76 unruptured cerebral aneurysms, 72 larger than 3 mm in diameter. All the latter were surgically treated. There was no operative mortality. Operative morbidity occurred in 5 patients (7.2%), including hemiplegia in 2 from obliteration of perforator vessels, transient memory impairment in 2 due to brain retraction, and transient oculomotor nerve palsy in 1 patient resulting from an unknown etiology. During the observation period, 53 patients (76.8%) had a good or fair outcome, 11 (15.9%) had a poor outcome, and 5 (7.3%) died from causes unrelated to the aneurysms, such as pneumonia, gastrointestinal bleeding, and heart failure. The 5-year survival rate was 94%. Statistical analysis of the long-term outcome of all patients showed no significantly important factor influencing long-term morbidity. Prophylactic surgery of aneurysm is recommended for low-risk patients who may develop eventual rupture of an aneurysm, but perforator vessels around the aneurysm should be preserved, clips should be properly placed, and brain retraction should be minimized.