[Surgical strategy in cases of multiple aneurysms]

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Intracranial aneurysms, particularly multiple aneurysms (MA), present complex surgical challenges.
• Subarachnoid hemorrhage (SAH) necessitates timely intervention for ruptured aneurysms.
• Optimal surgical strategies for MA versus single aneurysms (SA) require further investigation.

Purpose of the Study:

• To compare surgical outcomes between patients with multiple intracranial aneurysms (MA) and single aneurysms (SA).
• To evaluate the efficacy of one-stage versus two-stage operative approaches for MA.
• To determine the long-term recovery, morbidity, and mortality rates for both patient groups.

Main Methods:

• Retrospective analysis of 50 patients with MA and 283 patients with SA over a 4-year period.
• Surgical intervention timing, operative approach (including keyhole), and aneurysm occlusion techniques were recorded.
• Patient outcomes were assessed based on Hunt & Hess grading, recovery status, morbidity, and mortality at 1-year follow-up.

Main Results:

• No significant differences in Hunt & Hess grading or ruptured aneurysm distribution between MA and SA groups.
• Operative time was longer for MA, but did not significantly impact outcomes (p=0.163).
• Excellent or good recovery rates were 72% for MA and 65% for SA; morbidity (22% vs 30%) and mortality (6% vs 5%) showed no significant differences.

Conclusions:

• Surgical treatment for multiple intracranial aneurysms (MA) yields comparable outcomes to single aneurysms (SA).
• A one-stage procedure is feasible in 74% of MA cases, with tailored two-stage approaches for complex cases.
• Operative treatment of all identified aneurysms is recommended due to a significant annual bleeding risk.