Since 1997, we have used a preoperative surgical scoring for the surgical indication of unruptured cerebral aneurysms. The score includes aneurysm size (0: below 14 mm, 1: 15-24 mm, 2: over 25 mm), location (2: posterior fossa, 1: carotid cave, 0: others), associated systemic disease (0: none, 1: one, 2: two or more), and multiplicity (0: single approach, 1: multiple surgery). We investigated whether indication and complication differ before and after induction of scoring. There were 84 operated cases before induction of scoring and 55 cases after induction of scoring.
Compared to cases before induction of scoring, the age was higher than cases after induction of scoring. Posterior circulation aneurysms increased after induction of scoring, but 5 of 6 cases were treated with intravascular surgery. Major surgical complication (Rankin scale of III or more) decreased from 3.6 to 1.8% after induction of scoring. The minor complication (Rankin scale below II) did not decrease after induction of scoring.
The results indicate that intravascular surgery in cases of having a high preoperative score can reduce surgical complications.