SURGICAL OUTCOME FOR MULTIPLE INTRACRANIAL ANEURYSMS

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.