Ruptured Multiple Intracranial Aneurysms; Surgical Experience

Background: Multiple intracranial aneurysms are not infrequent disorder and represent a great challenge to vascular neurosurgeons. The surgical management should be based on the localization of the correct offending aneurysm among multiple aneurysms for occlusion and deciding the type of surgery either one stage or two stages surgery. Objective: This is a retrospective case series study analyzes the postoperative clinical and radiological outcome of twelve patients with ruptured multiple intracranial aneurysms operated upon. Patients and Methods: Patient selection: twelve patients with ruptured multiple intracranial aneurysms were operated upon and followed up clinically and radiologically for six months. Operation: Microsurgical clipping of multiple aneurysms in a one-stage operation in eight patients and in two-stages operations in four patients. Results: In the Neurosurgery Department, Cairo University Hospitals; from January 2011 through December 2014, twelve patients with ruptured multiple intracranial aneurysms underwent microsurgical clipping using classic pterional approach and followed up clinically and radiologically for six months. The total number of aneurysms in all patients was twenty seven aneurysms. Eight patients (66.7%) underwent one-stage operation for clipping of all aneurysms while four patients (33.3%) underwent two stages- operation. Total aneurysm occlusion was accomplished in 100% of the patients. With 6 months follow up interval ten patients (83.3%) regained their full activity (GOS 5) and two patient (16.7%) suffered from moderate disability (GOS4).No mortality was encountered. Conclusion: Microsurgical clipping of multiple intracranial aneurysms allows safe, effective and permanent repair in one-stage or two –stages operations. The craniotomy should be performed on the side of the ruptured aneurysm in order to be exposed and clipped first and when the unruptured aneurysms are difficult to be repaired, a contralateral craniotomy is recommended at a later stage.