Results of Surgical Treatment of Multiple Cerebral Aneurysms

Tkachev V., Krilov V.

Sklifosovsky Research Institute of Emergency Care, Moscow, Russia

 

The research goal was to carry out comparative analysis of outcomes in surgical treatment of cases with single (SA) and multiple aneurysms (MA).

Methods. The analysis of open operations, performed in 1390 cases in 1992-2004, was carried out.

Results. SA and MA were revealed in 1259 and 131 cases respectively. A number of aneurysms was as follows: 2 - 106, 3 - 22, 4 - 2, 5 - 1 cases. There were 291 aneurysms in 131 patients.
All the cases with MA were divided into the following groups:

Operations were performed in 62 cases with MA (47.3%) and 781 patients with SA (62%) at an early posthemorrhagic period; they were made 14 days after hemorrhage in 69 (52.7%) and 478 (38%) of cases respectively. A state severity of cases with MA was as follows (Hunt & Hess scale): Grade I - 11, Grade II - 46, Grade III - 64, Grade IV - 7, Grade V - 3. The same grades were watched in 88, 543, 560, 58, 10 cases with SA respectively. Outcomes in cases with MA were estimated on the basis of the Glasgow Coma Scale and were as follows: Grades I and II - 86 (65.6%), Grade III - 14 (10.7%), Grade IV - 1 (0.8%) Grade V (death) - 30 (22.9%). The same grades were observed in 941 (74.7%), 77 (6.1%), 15 (1.2%), 226 (18%) of cases with SA.

Conclusion. Up-to-date surgical tactics is characterized by similar rates of mortality in cases with MA and SA. Functional outcomes of survivors with MA are reliably worse. Thus, such cases can be referred to a group with a higher risk. Outcome improvement demands optimization of surgical tactics, wider use of endovascular surgery, development of indications for combined treatment of MA.