Manangement Outcome of 372 Patients with Unruptured Intracranial Aneurysms

Lee, Jae Whan; Huh, Seung Kon; Kim, Dong Ik; Lee, Kyu Chang

Abstract

OBJECTIVE
The purpose of this study was to provide management strategy and to improve management outcome of patients with unruptured intracranial aneurysms (UIA).
PATIENTS AND METHODS
The authors reviewed the database as sources for identifying and analyzing patients, and analyzed the management outcome of patients with UIA. From June 1979 to June 1999, among total of 1,801 patients treated for intracranial aneurysms, 372 patients with 437 unruptured aneurysms were treated by surgery (335 patients) or neurointervention (37 patients). One hundred and forty - three patients with 158 UIA had no history of SAH from a different aneurysm (group 1), and 229 patients with 279 UIA had a ruptured aneurysm that have been repaired simultaneously or before treatment of UIA (group 2). We reviewed the rate of favorable (good, fair) and unfavorable (poor or dead) outcome one year after the treatment.
RESULTS
The rate of favorable and unfavorable outcome in group 1 was 96.5% and 3.5% respectively. In Group 2, the rate was 93.5% and 6.5%. However, the most of the unfavorable outcome in group 2 came from treatment of the ruptured aneurysm, or SAH. The only significant factor contributed to unfavorable outcome in group 1 was size of UIA. Those of group 2 were age, Fisher grade, Hunt - Hess grade, and aneurysm number. Complications attributable to surgical or endovascular treatment of UIA that occurred in 38 of 372 patients (10.2%) were cerebral infarction (17), intracerebral hemorrhage (10), epidural hematoma (4), cranial nerve injury (3), infection (2), venous infarction (1), and subarachnoid hemorrhage (1).
CONCLUSION
Rupture of an intracranial aneurysm is a devastating event. The safe size below which rupture is unlikely is unclear. There appears to be increased risk from unruptured aneurysms discovered in SAH patients. All unruptured aneurysms in healthy patients as well as in patients with history of SAH should be repaired.