Retrospective Analysis Of Bilateral Multiple Intracranial Aneurysms Clipped By Unilateral Approach Microsurgery

Objective: To analyze the clinical data and preoperative imaging data of patients with bilateral multiple intracranial aneurysms microscopically clipped by unilateral approach retrospectively,and find some relevant imaging features,so as to select suitable cases for unilateral approach clipping of bilateral multiple intracranial aneurysms and summarize experience to improve the therapeutic effect.Methods: From September 2016 to August 2019,the clinical data and imaging data of 62 patients diagnosed as bilateral multiple intracranial aneurysms in the Department of Cerebrovascular Diseases and the United External Hospital of Zunyi Medical University were retrospectively analyzed.All patients underwent phase-I microsurgery through unilateral approach to clip bilateral multiple intracranial aneurysms.Hunt-Hess and Fisher grading were performed according to the conditions at admission,and the improved Rankin rating scale(mRS score)was performed at discharge to evaluate the clinical therapeutic effect.The general clinical data of the patients,the degree of cerebral edema on head CT before operation,the basic characteristics of aneurysm,including aneurysm morphology,size,tumor body orientation,imaging parameters related to contralateral aneurysm,operation time,treatment results and postoperative complications,were analyzed.Besides,the treatment experience were summarized.Results: Among 62 MIA patients,51 had SAH-related symptoms and 11 had no SAH-related symptoms.The onset age ranged from 28 to 75 years old,with an average age of 55.23 ± 9.81 years old.22 cases(35.48%)were male and 40 cases(64.52%)were female.59 cases(95.16%)had good prognosis and 3 cases(4.84%)had poor prognosis.The hospitalization time was 17.32 ± 4.71 days and the operation time was 3.93 ± 1.01 hours.According to preoperative imaging examination,143 intracranial aneurysms were found,all of which were saccular aneurysms,including 39 middle cerebral artery aneurysms,52 posterior communicating artery aneurysms,17 internal carotid aneurysms,7 ophthalmic artery aneurysms,11 anterior cerebral communicating artery aneurysms,8 anterior cerebral artery aneurysms and 9 anterior choroidal artery aneurysms.There were 17 aneurysms less than 3 mm,57 aneurysms less than 5 mm,43 aneurysms less than 7 mm,18 aneurysms with the size between 7 mm and 10 mm,8 aneurysms are 10 mm or more,but less than 25 mm,and no aneurysm is 25 mm or more.Preoperative head CT showed no cerebral edema in 11 cases,focal cerebral edema in 51 cases and no global cerebral edema cases.A total of 141 aneurysms were clipped by unilateral approach,39 of which were middle cerebral artery aneurysms,including 15 contralateral middle cerebral artery aneurysms.The total length of contralateral A1+M1 was 28.15 ± 1.91 mm,the shape of contralateral aneurysms was cystic,the average distance from contralateral aneurysms to the surgical approach was 83.41 ± 3.41 mm,and 3 cases were anterior and superior,7 cases were posterior and 5 cases were inferior.Seven ocular artery aneurysms were clipped,of which 3 were contralateral ocular artery aneurysms,cystic,with no calcification of tumor wall.The anterior distance of optic chiasm was 7.80 ± 0.62 mm,the distance between optic nerves was 12.83 ± 1.32 mm,the distance between horizontally bilateral internal carotid arteries of the tuberculum sellae was 12.83 ± 1.70 mm,the average distance between bilateral anterior clinoid processes was 28.07 ± 1.94 mm,the contralateral aneurysms were anterior medial in 1 case and medial in 2 cases.There were 52 posterior communicating artery aneurysms,17 internal carotid artery aneurysms,6 ophthalmic artery aneurysms,7 anterior cerebral artery aneurysms,11 anterior communicating artery aneurysms and 9 anterior choroidal artery aneurysms.Conclusions: 1.Hunt-Hess grade is zero-Ⅲ before operation,head CT showed focal cerebral edema,priority should be given to responsible aneurysms,and phase-I treatment of intracranial multiple aneurysms can be considered.2.When meeting specific anatomical and imaging parameters,the contralateral middle cerebral artery aneurysm and the contralateral ophthalmic artery aneurysm can be considered to be clipped by phase-I unilateral approach.3.For contralateral posterior communicating aneurysm and contralateral internal carotid artery aneurysm suitable in orientation and size,phase-I unilateral approach can be selected for clipping after comprehensive evaluation.