MULTIPLE INTRACRANIAL ANEURYSMS DISCOVERE D AFTER SUBARACHNOID HEMORRHAGE - ABOUT 60 CASES

In a series of 60 consecutive patients, 137 multiple aneurysms (An) we re discovered after subarachnoid hemorrhage. Multiple An were mostly d ouble (83 % of the patients). The incidence of middle cerebral artery An was 42 %, internal carotid artery An 25.5 %, anterior communicating artery An 15 %. Both angiography (A degrees) and CT scan could identi fy the ruptured An in 56 cases or at least the side of the ruptured An in the remaining 4 cases. Among the routine A degrees criteria used t o determine which one of the An had bled the most reliable ones appear s to be: the existence of vasospasm of the parent artery, the bigger s ize of the sac, the irregular wall of the sac. The incidence of ruptur e is the highest in anterior communicating artery An (16/21). When an An located on the polygene of Willis is associated to a distal An, the former ruptures in 17 cases/18. All ruptured An were treated during t he first operative session. In 47 patients (78.3 %) all the An, ruptur ed and asymptomatic, were treated during the first procedure or in one or two additional surgical sessions. In 13 patients (22.7 %) for seve ral reasons only ruptured An and asymptomatic An that could be reached via the same craniotomy were treated. There was no morbidity or morta lity related to the surgical treatment of asymptomatic An.