Abstract
Surgical indication for patients who harbor unruptured intracranial aneurysms still remains indefinite. We investigated the management outcome in 150 patients with unruptured aneurysms, to evaluate the benefit of preventive surgery. Twenty-three of the patients had symptomatic aneurysms. Surgical therapy was planned in patients 70 years old or younger with no or mild systemic complications. Ninety-four patients underwent surgery, including 5 endovascular interventions, and conservative treatment was chosen in the remaining 56 patients. In the surgical group, 4 patients (4.5%) became moderately disabled, and 3 patients (3.4%) severely disabled after surgery. No mortality directly related to operation was observed, while 1 patient died of myocardial infarction 4 years after surgery. There was no morbi-mortality after endovascular therapy. Among the patients who underwent conservative therapy, 4 suffered from subsequent aneurysm rupture during the total follow-up period of 155 years. The annual rupture rate was estimated at 2.6%. Clinical decision analysis based on our data demonstrated that preventive surgery is beneficial for a Japanese 70 years old or younger. If the annual rupture rate was set at 0.5%, the expected utility was almost the same in both the surgical and conservative group. Though our surgical indication appears to be valid from our own results, both the estimated risk of rupture and operative results affect surgical indication.
