Surgical Treatment of Unruptured Intracranial Aneurysms

Surgical results were studied in a series of 24 patients with incidental asymptomatic unruptured intracranial aneurysms. The indications for neuroradiological study resulting in incidental findings of these aneurysms were cerebral ischemia in 10 cases, ischemic heart disease in 4, headache in 4, intracerebral hemorrhage in 2, visual disturbance in 2, seizure, and hemifacial spasm in one each. In the patients with ischemic heart disease, screening cerebral angiography was performed during coronary angiography. Unruptured aneurysms identified at the time of investigation of subarachnoid hemorrhage were excluded. Twenty-four of 27 aneurysms were clipped and three were wrapped. STA-MCA anastomosis was performed at the same stage in two cases. Among these patients, there were no operative mortality. Twenty of 24 patients (83%) showed no neurological deficits or no neurological deterioration. Operative morbidity occurred in 4 cases (17%). Of these, two patients with cerebral infarction had a basilar tip aneurysm and developed new cerebral infarction in the thalamus, because perforating arteries were injured during surgery. One suffered lacunar infarction three days after surgery. Postoperative intracerebral hematoma due to brain retraction was encountered in an elderly patient. Other complications were hydrocephalus, transient oculomotor palsy, and convulsion. We concluded that the decision to surgically manage unruptured aneurysms should be made carefully, especially in patients with a basilar aneurysm and/or ischemic cerebrovascular disease. Moreover, cautious and delicate surgical manipulations are mandatory for less operative morbidity.