Treatment of Unruptured Aneurysm in Cases with Occlusive Cerebrovascular Diseases

Abstract

The authors analyzed a series of 38 cases of occlusive cerebrovascular disease with unruptured aneurysms. There were 16 patients who underwent direct surgery for unruptured aneurysms and 22 patients who were treated conservatively.
Surgical morbidity occured in three cases. One developed visual loss due to optic nerve injury, and the other two patients had aggravation of ischemic symptoms after operation. Of the latter two patients, one underwent surgery in the acute stage of stroke and the other showed a high density in the ischemic lesion on CT scans even in the chronic stage of ischemia. In each of these three cases, operation for aneurysms was performed with an ipsilateral approach to the ischemic lesion. Of 22 patients who did not undergo surgery, only one patient suffered aneurysmal rupture and three patients over 70 years of age died of other causes during the follow-up period (mean: 2.3 years). The risk of hemorrhage was 2%/year.
When considering surgery for unruptured aneurysms in patients with occlusive cerebrovascular disease, one should compare the risk of aneurysmal rupture against that of surgery. From our results, we have decided several criteria for surgery for unruptured aneurysms with ischemic stroke:1) Age must be under 70 years; 2) General condition must be good; 3) Ischemic symptoms must be minor; 4) More than two months must have passed from the onset of the last ischemic attack. In addition, more caution should be exercised when surgery is performed with an ipsilateral approach to the ischemic lesion.