Microsurgery For Unruptured Intracranial Aneurysms (the Report Of 59 Cases)

Object: The aim of this study was to explore the surgical outcome of microsurgical treatment of Unruptured Intracranial Aneurysms(UIA) through a retrospective analysis of 59 patients with UIA.Methods:In this article, we retrospected and followed up 59 patients with 64 UIA treated with microsurgery in China-Japan Union Hospital of Jilin University during from Jan.1999 to Dec.2009.There were three categories of UIA by their finding ways, first, UIA discovered by chance (accidental group), second, symptomatic UIA (symptomatic group), the third, multiple UIA (multiple groups), in our study the total number of patients of each groups are 5,19,and 35 respectively. All the patients underwent Microsurgical Treatment. The accidental group and symptomatic group were complete surgery at the first time, while in multiple group, 21 patients with UIA was treated along with the ruptured aneurysm surgery, and the other 14 cases was suffer from the second operation 3 weeks later until good restoration of the first operation. There were mainly three operative approaches, pterional, extended frontotemporal pterional, and amount - orbital - zygomatic pterional (paraclinoid giant aneurysms). Aneurysmal neck clipping operation was in 59 patients, clipping plus wrapping was in 3 patients, and simply wrapping was in 2 patients.Results: The percentages of rates of the in overall good prognosis, disability, and mortality were 86.44, 10.17, and 3.39 respectively. In death cases, 1 patient of the accidental group died from the sudden cardiac death which was not directly caused by surgical factors; and 1 patient of multiple group died from occipital and brain stem infarction. 6 severely disabled patients all come from the multiple group, including five cases result from serious complications caused by the operation on the rupture of the aneurysm, in which situation no matter whether treated the unruptured aneurysm or not, the results would be poor; the other one case of severely disabled patients (unilateral paralysis of limbs) dued to cerebral infarction after second surgery. In view of greater impact that the ruptured aneurysm itself on the evaluation of prognosis, and the fact that the only death case of accidental group was not directly caused by surgery, so after excluding aforementioned cases (37 patients left), the overall good progenosis rate was 94.59%. The rate of favorable surgical outcome about accidental group, the symptomatic group and multiple were 100%,100% and 85.71% respectively when they discharged from hospital. No difference was found among the three group(p>0.05). When comes to the followed up 45 cases, the average follow-up period is 3.6 years, no re-bleeding cases, and the good prognosis rate was 91.11% (GOS 5 +4 cases), accidental and symptomatic group prognosis was 100% good, and 4 patients with poor prognosis all come from the multiple group. There is no significant difference in the good prognosis rate with different ages, aneurysm size and location (p>0.05); however, A significant difference was found between Single and multiple aneurysm group in the rate of poor prognosis (p<0.05);Conclusion:1. Microsurgical clipping of UIA could effectively prevent aneurysm rupture. 2. Microsurgical treatment of anterior circulation UIA had a good effect. 3. Mortality and disability rates of accidentally discovered and symptomatic aneurysms were low. 4. For multiple aneurysms, if we can deal with the UIA through the same approach as ruptured aneurysm together, we had better treat them simultaneously at the first operation, otherwise, UIA should receive re-operation when the patients in good condition at least 3 weeks later, rather than concurrently treated with ruptured aneurysm. 5.When we decide whether and how to deal with the discovered UIA, we should take the facts into account such as patient's age, physical condition, aneurysm location, size, and shape, physician technological level and hospital equipment conditions. With an eye to the facts follows, UIA rupture rate is not low, the consequences are serious once it ruptures, the security of treatment increased, and people live longer, the general trend for UIA therapy is assessing the rupture risk of UIA more accurately, selecting the high-risk cases of rupture, and giving active treatment.