SURGICAL-MANAGEMENT OF UNRUPTURED INTRACRANIAL ANEURYSMS

The surgical management of patients with unruptured intracranial aneur ysms continues to be controversial. The criteria for withholding treat ment or choosing between endovascular embolization and conventional mi crosurgery are not well delineated. The present study analyzes the mor bidity and mortality that can be expected with modern surgical managem ent of unruptured aneurysms, and therefore serves as a point of refere nce for clinical decision-making in this group of patients. A total of 202 consecutive operations for attempted clipping of unruptured intra cranial aneurysms are reported. Subarachnoid hemorrhage from another a neurysm was the most common presentation (55 cases). Thirty-seven pati ents presented with headache, 36 with mass effect from the aneurysm, a nd 19 with embolic events; 11 aneurysms were associated with an arteri ovenous malformation, 10 caused seizures, and 34 were incidental findi ngs. Excellent or good outcome was achieved in 100% of patients with a neurysms less than 10 mm in diameter, 95% with aneurysms 11 to 25 mm, and 79% with aneurysms greater than 25 mm. Except for giant basilar an eurysms, size (and not location) of the aneurysm was the key predictor of risk for surgical morbidity. These data may be useful when discuss ing with patients the risk:benefit ratio of choosing between conservat ive management, endovascular embolization, and microsurgical clipping.