This study is based on eighty-five cases of unruptured asymptomatic aneurysms associated with ischemic cerebrovascular disease. Sixty-one cases (73 aneurysms) were treated surgically and 24 cases were treated non-surgically. The post-operative course was uneventful in 50 out of 61 cases (82%) and unsatisfactory in 11 cases (18%). There was no significant relation of the surgical results to site of aneurysm, type of stroke, or pre-operative CT and angiographical findings. The results appeared to correlate with patients' age and surgical technique. In the 11 unsatisfactory cases, symptoms worsened due to an intracerebral hematoma (ICH), an enlargement of the infarcted area or a subarachnoid hemorrhage (SAH). The cause of death in five cases, three of which were patients over 70, was attributed to acute myocardial infarction in 2 cases, large post-operative ICH in 2 cases and SAH in 1 case.
In the 24 cases without surgery, only one aneurysm ruptured during 1-7 years follow-up.
Based on these results, surgery might be indicated for cases with complicated lesions to prevent future SAH due to rupture of aneurysm and stroke following TIA. However, surgery is associated with a high rate of post-operative complications, because ischemic brain tissue is very vulnerable to retraction pressure. Patients over 70 with these complicated lesions should be excluded from surgical indication.
