Unruptured Intracranial Aneurysms: Surgery Still Safe as a Treatment Option

BACKGROUND: Despite a number of studies on the treatment of unruptured intracranial aneurysms (UIA), the optimal method still remains unclear. OBJECTIVES: The aim of the study was to demonstrate that UIA clipping is a safe procedure and can be a good alternative for patients not qualified for endovascular procedures and who have refused conservative management. MATERIAL AND METHODS: Results were gathered from a sample of 104 patients with UIA treated in our facility over a 9-year period starting January 2005. The data from a medical database was collected, followed by a long-term assessment of the functional outcomes using the modified Rankin Scale (mRS) and of quality of life (QoL) using a SF-36 questionnaire and comparing it to a Polish population reference. RESULTS: Overall postoperative morbidity was 5.7% and the mortality rate was 0%. The mean follow-up period was 6.5 years. A favorable outcome (mRS 0-2) was achieved in all the patients. Ninety-eight patients achieved an mRS score of 0, 2 patients an mRS score of 1, and 4 patients an mRS score of 2. All patients lived at home. Sixty-nine point two percent were fully employed, 27.0% were retired because of age, and only 3.8% relied on government help due to postoperative disability. The QoL index was similar to that of the standard Polish population. CONCLUSIONS: In unruptured cerebral aneurysms, clipping is a safe procedure that provides good outcomes and an unaffected quality of life. It remains a good option especially for patients with MCA aneurysms that are not appropriate for endovascular management.