The surgical outcome of 221 cases with multiple intracranial aneurysms
operated upon during the years 1988 to 1994 were reviewed. The patien
ts were classified into three groups according to the locations of the
aneurysms; group 1: multiple aneurysms located unilaterally in the an
terior circulation only (147 cases); group 2: multiple aneurysms locat
ed bilaterally in the anterior circulation only (44 cases) and group 3
: multiple aneurysms located in both anterior and posterior circulatio
n or in the posterior circulation alone (30 cases). In 132 cases of gr
oup 1 (89.8%) all aneurysms were treated in one-stage operations. Twen
ty-eight patients from group 2 (63.6%) received partial treatment, whe
re only the ruptured or the symptomatic aneurysms were treated. In 12
other cases from group 2 (27.3%) all multiple aneurysms were treated i
n two-stage operations. In group 3 patients, one-stage operations were
performed in 18 cases (60%), while 9 patients (30%) received partial
treatment only. Of the 221 multiple aneurysm cases, 162 (73.3%) presen
ted with manifestations of subarachnoid haemorrhage (SAH). The remaini
ng 59 multiple aneurysms cases (26.7%) presented with manifestations o
ther than SAH (unruptured aneurysms). In the postoperative follow-up,
of the 221 multiple aneurysms cases, 113 (51.1%) were free of neurolog
ical deficit (excellent), 48 cases (21.7%) were capable of leading an
independent life (good), 32 cases (14.5%) were not independent and nee
ded to be assisted (fair), and 28 patients (12.7%) died. These results
were comparable to the results of patients with single aneurysms oper
ated on during the same period. Based on our results, we recommend tha
t whenever possible all multiple aneurysms should be treated in one-st
age operations. In unruptured multiple aneurysm cases surgical managem
ent is the recommended treatment. In poor grade SAH patients or unrupt
ured multiple aneurysms in old patients, two-stage operations or parti
al treatment of only the ruptured or the symptomatic aneurysms may be
adopted.