Surgical Management of Unruptured Aneurysm

Cho, Byung Moon; Oh, Sae Moon; Shin, Dong Ik; Park, Se Hyuck; Koh, Young Cho; Lee, Kyo Ho; Ahn, Mynug Soo; Choi, Sun Kil; Hwang, Do Yoon

Abstract

The surgical management of patients with unruptured intracranial aneurysm continues to be controversial. To provide current data about surgical outcome of patients with unruptured intracranial aneurysm, we retrospectively reviewed 494 consecutive intracranial aneurysm patients who underwent surgery between January 1990 and May 1995. Among these 494, 16 patients with unruptured aneurysms were evaluated; those with unruptured aneurysm associated with ruptured aneurysm or arteriovenous malformation were excluded. Mode of presentation, location and size of aneurysm, surgical method and complications, and surgical result were analyzed. Evaluation revealed four patients with asymptomatic and 12 with symptomatic unruptured aneurysm. Of these 12, seven presented with mass effect, four with headache, and one with cerebral infarction. The aneurysms were located in the internal carotid artery(n=8), the middle cerebral artery(n=3), the vertebral artery(n=3), the anterior communicating artery(n=2), and the basilar artery(n=2). They ranged in size from smaller than 10mm to larger than 25mm(<10mm: 10 cases, 10-25mm: 5 cases, >25mm: 1 case). An excellent or good outcome was achieved in 12 patients, including four with asymptomatic intracranial aneurysm. In three patients there were complications or sequelae and one died due to premature rupture of the aneurysm. We concluded that in patients harboring an unruptured intracranial aneurysm, aggressive early detection and surgical treatment may improve the outcome by preventing the devastating effects of subarachnoid hemorrhage.