Abstract
The major purpose of aneurysm surgery is to completely prevent bleeding from intracranial aneurysm (“complete” surgery), without any neurological deficit due to the surgical procedure (“safe” surgery). We evaluated the achievement of this “complete” and “safe” surgery for intracranial aneurysms by retrospectively analyzing Hunt and Kosnik Grade I and II cases with ruptured aneurysm and also cases with unruptured aneurysm.“Complete” surgery is defined as complete clipping of aneurysmal neck, neck clipping plus neck coating, or complete coating of small hemispherical aneurysm.“Safe” surgery is defined as the absence of new neurological deficits due to surgical procedure. Included in this study were 343 Grade I cases and 130 Grade II cases with ruptured aneurysm (RA), 25 unruptured symptomatic aneurysms (US) and 83 unruptured incidental aneurysms (UI).“Complete” surgery was not performed in 6 in RA, 5 in US and 2 in UI. Vertebrobasilar giant aneurysms tended to be incompletely treated by surgery.“Safe” surgery was not done in 8 in RA, 5 in US and 10 in UI. Large or giant posterior circulation aneurysms and basilar terminal aneurysms with high-positioned neck tended to have experienced post-surgical neurological deterioration.
In these aneurysms,“complete and safe” surgery for aneurysm is often difficult. Surgical manipulation for them should be more carefully performed so as not to injure perforating arteries. Endovascular embolization of aneurysm should be considered as an alternative.
