Surgical Treatment of Bilateral Intracranial Aneurysms

Chang, Chul Hoon; Sohn, Moon Jun; Kwun, Byung Duk; Jeon, Sang Ryong; Lyo, In Uk; Kim, Jung Hoon; Ra, Young Shin; Kim, Chang Jin; Kwon, Yang; Rhim, Seung Chul; Lee, Jung Kyo

Abstract

The incidence of the bilateral intracranial aneurysms in multiple aneurysms ranges from 20 to 40% in the published series12). The problems of surgery for multiple aneurysms are far greater than those for single aneurysm. Occasionally,the ruptured site of bilateral symmetrical(mirror image) aneurysms are more difficult to identify. To verify the standard treament, we investigated their clinical data and surgical modalities of 43 patients with bilateral aneurysms. We classified the bilateral aneurysms as symmetrical and asymmetrical aneurysms. Most common bilateral symmetrical aneurysms were located at origin of posterior communicating artery. Surgical modalities were separate craniotomy with ipsilateral approach(29 cases) and a single craniotomy with ipsilateral and contralateral approach (6 cases). The rest of patients were treated only in the presence of symatomatic lesions. Seven patients died of various causes; two were rebleeding, three were surgical mortalities, and two had medical complications. The surgical results were good to fair in 26 cases of separate operation and had good to fair outcome of 5 cases with 1 case of poor outcome in the single craniotomy with combined ipsilateral and contralateral approach. Surgical goal in patient with bilateral aneruysms is clipping of all aneurysms. In selected cases, the contralateral approach with a single craniotomy can be employed. Proper surgical techniques and guideline for microsurgical exposure of bilateral aneurysms are mandatory.