Abstract
A hundred and eight patients with unruptured aneurysms, who received surgical (78 patients) or medical treatments (30 patients) in Kanazawa University Hospital between 1976 and 1991, were studied with respect to their operative and follow-up results. Thirty-four were male and 74 were female. The age ranged from 13 to 84 years (mean, 56.2 years). Unruptured aneurysms were discovered incidentally in 40 cases, as one of multiple aneurysms in 32 cases with subarachnoid hemorrhage (SAH), and as symptomatic ones in 36 cases. The operative morbidity was 2.0% (a case in 49 cases, 1/49) with a small aneurysm (smaller than 10mm), 37.5% (3/8) with a large aneurysm (10-25mm in size), 19.0% (4/21) with a giant aneurysm (larger than 25mm), and 10.3% (8/78) in the total cases, respectively; the operative mortality, 0% (0/49), 12.5% (1/8), 19% (4/21), and 6.4% (5/78), respectively. The operative results were poor in the patients aged over 50 with a giant aneurysm and over 70 with a large one. Among 30 patients who were not operated on, nine patients (30.0%) experienced aneurysmal rupture between 4 months and 13 years (mean, 5.0 years). As regards the size of aneurysms, large ones most frequently ruptured. Untreated small ones of the multiple ones after subarachnoid hemorrhage also frequently ruptured. No giant ones ruptured in patients aged over 60. Among 15 patients who underwent palliative surgeries such as coating of aneurysm and parent artery ligation, two patients with a giant aneurysm died of aneurysmal rupture one year after surgery. The incidence of aneurysmal rupture exceeded the operative risk in the patients aged less than 70. These results show as follows: 1) unruptured small aneurysms, once discovered, should be operated on only when patients, even aged, have no risk factor such as a cerebral ischemic disease. 2) There might be indications for surgeries of giant aneurysms of patients aged less than 60 and of large ones of those less than 70, however, safer operative procedures need to be conducted. 3) Clipping is a radical surgery for aneurysms however, palliative surgeries such as aneurysmal trapping and parent artery occlusion combined with a bypass surgery might be preferable to clipping for (symptomatic) large and giant aneurysms.
