Abstract
About five percent of patients who undergo cerebral angiography for the evaluation of ischemic vascular lesions will be found to have an incidental intracranial aneurysm. However, controversy exists about the treatment for this condition. Since 1978, the authors have operated on six patients with symptomatic intracranial aneurysms which were accompanied by ischemic symptoms. All these patients showed minor completed stroke. Cerebral angiograms showed branch occlusion of the middle cerebral artery (MCA) with aneurysms in two cases, stenosis of the internal carotid artery with aneurysms in two, wall irregularity of the MCA with multiple aneurysms in one case and a partially thrombosed ophthalmic aneurysm causing cerebral embolism in the last case. Three patients were treated by aneurysm clipping, and superficial temporal artery to middle cerebral artery bypass was performed at the same time. One patient, (Case 5), underwent clipping of the aneurysm one month after carotid endarterectomy. Another, (Case 6), was treated by clipping of a right side aneurysm one month after the clipping of multiple aneurysms on the left side. Operative results were good in all cases of one stage operations but there were complications in the two stage operations. From our own operative results and from the literature, the authors have discussed treatment for asymptomatic cerebral aneurysm when accompanied by ischemic events and have concluded that the combined therapy of aneurysm clipping and bypass surgery in a one-stage operation may be a useful method for preventing complications.
