RUPTURED AND UNRUPTURED INTRACRANIAL ANEURYSMS - SURGICAL OUTCOME

Background: The treatment of unruptured, intracranial aneurysms has be en the topic of debate. Although recent studies have advocated surgica l intervention for unruptured aneurysms, the risk of such treatment in comparison to outcome from ruptured aneurysms has not been establishe d. Method: This retrospective study examines the outcome of 134 patien ts with 179 ruptured and unruptured intracranial, saccular aneurysms t reated by a single surgeon. Results: Of the 98 ruptured aneurysms wher e early surgical intervention was undertaken (less than 48 hours post hemorrhage), 70 had an excellent outcome, 13 were good, four were mode rate, two poor and nine patients died postoperatively. Outcome assessm ent in these cases was correlated to preoperative neurological status. Patients who presented with unruptured aneurysms fell into two catego ries: symptomatic and asymptomatic. Seven incidental, asymptomatic ane urysms were clipped concurrently to the surgical isolation of the culp rit lesion following subarachnoid hemorrhage without influencing outco me, whilst, for varying reasons, eight unruptured aneurysms were not o perated upon. Of the remaining 66 surgically treated, unruptured aneur ysms, 64 had an excellent postoperative result, one was good (persisti ng right incomplete third nerve palsy) and one was moderate (left hemi paresis). Thirteen of these aneurysms were symptomatic, whilst 21 were asymptomatic, multiple aneurysms requiring secondary elective repair and 32 were true incidental aneurysms. Conclusion: Unruptured aneurysm s less than 25 mm in size may be safely, surgically treated relative t o the expected natural history and, certainly, with less risk than ope rative intervention upon ruptured cerebral aneurysms.