Analysis of surgical treatment for asymptomatic unruptured aneurysms in the brain check-up

The incidence of asymptomatic unruptured aneurysms detected in brain checkup has increased in Japan. The surgical management is very important for preventing subarachnoid hemorrhage. When the patient has other brain diseases, high surgical risk is considered. The authors analyze surgical treatment of unruptured asymptomatic aneurysms without subarachnoid hemorrhage, and also examine for other asymptomatic brain diseases. We have experienced 104 cases of unruptured cerebral aneurysms without subarachnoid hemorrhage. Seventy-two cases are associated without other asymptomatic brain diseases, and 32 cases with other brain diseases. “Other brain diseases” means cerebral infarction, intracerebral hemorrhage, AVM, and so on. Surgical treatment was performed by clipping and/or coating. We have investigated CBF in some cases before operation and used intra-operative monitoring technique to minimize perioperative complications. Operative complications, such as cranial nerve palsy, cerebral infarction, mental disorder, were seen in 30 of 104 cases. The incidence of operative complications was higher in cases of aneurysm of posterior circulation and large or giant aneurysm. Most of them were reversible, and only 3 cases showed permanent neurological deficits. Overall operative morbidity in our series was 2.9% ( ). Morbidity and mortality in cases without other brain diseases were 2.8% ( ) and 0%, but higher in cases with other brain diseases (morbidity: 3.1% ( ), mortality: 3.1% ( )). Pre-operative examination of CBF and intra-operative monitoring are useful and necessary to prevent operative complications