Surgical Management of Unruptured Intracranial Aneurysms

Results ：The main locations of the aneurysms were：middle cerebral artery 31% internal carotid-posterior communicating artery 28% anterior communicating artery 16% paraclinoid 6.5% internal carotid-anterior choroidal artery 7% posterior circulation 7%. Forty three percent of the aneurysms were symptomatic and 57% asymptomatic. The overall outcome of the surgery was：Glasgow outcome scale(GOS Ⅰ 86% GOS Ⅱ 6% GOS Ⅲ 4.3% GOS Ⅳ 0% and GOS V(death 3.5%. The operative risk is higher for large to giant aneurysms and for aneurysms in posterior circulations. Patients with non-giant aneurysm in anterior circulation showed no mortality but morbidity of 8.2% and in posterior circulation： 25% of mortality and 75% of morbidity. Patients with giant anterior circulation aneurysm have 22% of mortality and 22% of morbidity. For patients with giant posterior circulation aneurysm mortality and morbidity were 25% and 25% respectively. The postoperative deaths were related to occlusion of the major parent artery in 3 cases(75%. The postoperative morbidity was related to occlusion of artery(9/13 intraoperative rupture(3/13 and cranial nerve injury(1/13. Conclusion：This report documents 3.5% mortality and 13% of morbidity in t he clipping surgery for unruptured intracranial aneurysms and the relatively low risk of surgical clipping in non-giant and those located in anterior circulation. The natural history especially risk of bleeding of the unruptured intracranial aneurysms is still controversial. However with respect to surgical results unruptured non-giant aneurysm located in anterior circulation should be operated in patients with low risk.