Abstract
Among 1,609 patients with hypertensive intracerebral hemorrhage (HIH) examined between April 1969 and October 1986 (17 years and seven months), 1,054 patients were given cerebral angiography (65.5%). Among them, 47 cases were combined with unruptured cerebral aneurysms (4.5%). Incidence of cerebral aneurysms was more frequent in the medial type (7.9%) than the lateral type (3.2%). Thirty-nine aneurysms were revealed in 30 cases receiving bilateral carotid angiography. Twenty-six of these aneurysms (66.7%) were located in the internal carotid and middle cerebral arteries at the ipsilateral side of the HIH. Surgical treatment of unruptured aneurysms was performed in 27 cases (57.4%). The operative morbidity and mortality rates were each 7.4%. Twenty cases (42.6%) were not surgically treated for their unruptured aneurysms because of severity of the HIH, complications, advanced age or severe sclerosis. Two of them (10%) died of ruptured aneurysms within three years.
Surgical indications for unruptured aneurysms should be considered carefully, especially in cases combined with HIH. The principle of treatment for unruptured aneurysms combined with HIH is as follow. Treatment of the HIH is preferred, and if surgical treatment for the HIH is needed and an unruptured aneurysms is located on the same side as the HIH, the surgical treatment of the unruptured aneurysm can be done simultaneously, or at the cranioplasty. In other cases surgery for unruptured aneurysms should be done later when the patients have resumed sufficient activity in their daily lives and have no severe complications.
