抄録
Indications for surgery of multiple and unruptured aneurysm remain controversial. This report evaluated the long-term outcome in 62 patients with multiple aneurysms who suffered from a subarachnoid hemorrhage.
Of the 62 patients, 29 were surgically treated on only the ruptured aneurysm (group A) and 33 on both ruptured and unruptured aneurysms (group B). During a 5.5-year follow-up period, four (13.8%) of the 29 patients in group A bled from unruptured aneurysm. The mean risk of hemorrhage was 2.5% per year. Two of the 4 patients died and two became disabled.
The analysis of the long-term outcome during a 4.5-year follow-up period in group B indicated that the factors of poor final outcomes were age over 66 years, systemic disease, severe vasospasms and high neurological grade (Hunt and Kosnik grade IV) on admission.
A comparative study between ruptured and unruptured aneurysms on size, location and shape of aneurysms was made angiographically and showed that aneurysms that were rod-shaped, larger than 5 mm, with bleb and anterior communicating artery aneurysm tended to rupture.
In conclusion, indications for surgical treatment of multiple and unruptured aneurysms are as follows: 1. age of less than 65 years and no severe systemic disease, 2. uneventful recovery from the initial subarachnoid hemorrhage, 3. rod-shaped aneurysm larger than 5mm with bleb, 4. aneurysm at the anterior communicating artery.
