Importance of management of unruptured cerebral aneurysms

BACKGROUND Since excellent recovery is hardly expected in patients with severe subarachnoid hemorrhage, management of unruptured aneurysms is essential in reducing the overall mortality and morbidity rates. The widespread use of less invasive imaging tools such as magnetic resonance angiography (MRA) has made ''Brain Check-up Systems'' very popular in Japan. Therefore, unruptured aneurysms have been found much more often than before. METHODS During the 1-year period of 1994, 80 patients underwent radical surgery for aneurysms in our institute. Thirty-two patients (40%) underwent surgery for unruptured aneurysms, while 48 patients (60%) underwent surgery for ruptured aneurysms. In patients with unruptured aneurysms, we have operated when the aneurysm is larger than approximately 5 mm in diameter, arising from the common sites in the circle of Willis, and when the patient's age is under 70 years. To prevent surgical complications in unruptured aneurysms, we often use a wrapping technique with Bemsheets (cotton) and adhesives. RESULTS The outcomes were good in all 32 cases of unruptured aneurysms. CONCLUSIONS We believe that early detection and prophylactic surgery for unruptured aneurysms will improve the overall outcome of aneurysm treatment in the future. (C) 1997 by Elsevier Science Inc.