Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(02): 268-273
DOI: 10.1055/s-0042-1750822
Original Article

Clinical Characteristics and Outcome of Patients with Multiple Intracranial Aneurysms from a University Hospital in Nepal

Mohan Raj Sharma 
1   Department of Neurosurgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
,
Prakash Kafle
2   Department of Neurosurgery, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
,
Binod Rajbhandari
1   Department of Neurosurgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
,
Amit Bahadur Pradhanang
1   Department of Neurosurgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
,
Shrestha Dipendra Kumar
1   Department of Neurosurgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
,
Gopal Sedain
1   Department of Neurosurgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective The risk factors, management strategies, and outcomes of patients with multiple intracranial aneurysms (MIAs) are different compared with that of patients with a single aneurysm. Data are scarce regarding patients with MIAs from developing countries. The objective of this study was to describe the clinical characteristics, management strategies, and outcomes of patients treated microsurgically from Nepal.

Methods The clinical records of patients confirmed to have MIAs and microsurgically clipped between July 2014 and December 2019 were retrospectively reviewed. Data on demographic and clinical characteristics, computed tomography findings, multiplicity and location of aneurysms, management strategies, and the 1-year outcome were abstracted and analyzed.

Results Two hundred cerebral aneurysms were microsurgically clipped in 170 consecutive patients during the study period. Twenty-six (13.0%) patients harbored 60 aneurysms. The mean age of the patients was 58.5 (43–73) years. Smoking and hypertension were found in 20 (76.9%) and 16 (61.5%) patients, respectively. The majority of patients [17 (65.4%)] were in good grades at presentation. Twenty-one patients had two aneurysms, four had three aneurysms, and one patient had five aneurysms. The middle cerebral artery was the commonest (20) followed by distal anterior cerebral artery (14) and anterior communicating artery (13) involved in multiplicity. A single-stage surgery was performed on 17 patients. Serial clipping was performed in six patients. In three patients, a single aneurysm on the contralateral side was left untreated for various reasons. The favorable outcome was achieved in 23 (88.5%) patients whereas three (11.5%) patients had an unfavorable outcome. One patient died.

Conclusion The demographic and clinical characteristics of patients in our series are comparable with those described in the published literature from other countries. With an individualized treatment strategy, an acceptable outcome can be achieved in the majority of the patients.

Keywords

microsurgical clipping - multiple intracranial aneurysms - Nepal - subarachnoid hemorrhage


Publication History

Article published online:
24 August 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ostergaard JR, Høg E. Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 1985; 63 (01) 49-55
    CrossrefPubMedSearch in Google Scholar
  • 2 Inagawa T. Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 1990; 106 (3-4): 119-126
    CrossrefPubMedSearch in Google Scholar
  • 3 Rinne J, Hernesniemi J, Puranen M, Saari T. Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 1994; 35 (05) 803-808
    CrossrefPubMedSearch in Google Scholar
  • 4 Qureshi AI, Suarez JI, Parekh PD. et al. Risk factors for multiple intracranial aneurysms. Neurosurgery 1998; 43 (01) 22-26 , discussion 26–27
    CrossrefPubMedSearch in Google Scholar
  • 5 Juvela S. Risk factors for multiple intracranial aneurysms. Stroke 2000; 31 (02) 392-397
    CrossrefPubMedSearch in Google Scholar
  • 6 Ellamushi HE, Grieve JP, Jäger HR, Kitchen ND. Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg 2001; 94 (05) 728-732
    CrossrefPubMedSearch in Google Scholar
  • 7 McDowell MM, Zhao Y, Kellner CP. et al. Demographic and clinical predictors of multiple intracranial aneurysms in patients with subarachnoid hemorrhage. J Neurosurg 2018; 128 (04) 961-968
    CrossrefPubMedSearch in Google Scholar
  • 8 Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke 2003; 34 (01) 16-21
    CrossrefPubMedSearch in Google Scholar
  • 9 Nehls DG, Flom RA, Carter LP, Spetzler RF. Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 1985; 63 (03) 342-348
    CrossrefPubMedSearch in Google Scholar
  • 10 Sai Kiran NA, Raj V, Sivaraju L, Vidyasagar K, Mohan D, Hegde AS. Outcome of microsurgical clipping for multiple versus single intracranial aneurysms: a single-institution retrospective comparative cohort study. World Neurosurg 2020; 143: e590-e603
    CrossrefPubMedSearch in Google Scholar
  • 11 Sharma P, Mehrotra A, Das KK. et al. Factors predicting poor outcome in a surgically managed series of multiple intracranial aneurysms. World Neurosurg 2016; 90: 29-37
    CrossrefPubMedSearch in Google Scholar
  • 12 Agha RA, Sohrabi C, Mathew G, Franchi T, Kerwan A, O'Neill N. PROCESS Group. The PROCESS 2020 Guideline: updating Consensus Preferred Reporting Of CasESeries in Surgery (PROCESS) Guidelines. Int J Surg 2020; 84: 231-235
    CrossrefPubMedSearch in Google Scholar
  • 13 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28 (01) 14-20
    CrossrefPubMedSearch in Google Scholar
  • 14 Connolly Jr ES, Rabinstein AA, Carhuapoma JR. et al; American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43 (06) 1711-1737
    CrossrefPubMedSearch in Google Scholar
  • 15 Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1 (7905): 480-484
    CrossrefPubMedSearch in Google Scholar
  • 16 Mont'alverne F, Tournade A, Riquelme C, Musacchio M. Multiple intracranial aneurysms. Angiographic study and endovascular treatment. Interv Neuroradiol 2002; 8 (02) 95-106
    CrossrefPubMedSearch in Google Scholar
  • 17 Wachter D, Kreitschmann-Andermahr I, Gilsbach JM, Rohde V. Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm?. J Neurosurg 2011; 114 (04) 935-941
    CrossrefPubMedSearch in Google Scholar
  • 18 Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke 2010; 41 (09) 1969-1977
    CrossrefPubMedSearch in Google Scholar
  • 19 Brisman R. Management of multiple and asymptomatic aneurysms. In: Fein JM, Flamm ES. eds. Cerebrovascular Surgery. 3rd vol. New York: Springer; 1985: 983-995
    Search in Google Scholar
  • 20 Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir (Wien) 1989; 96 (1-2): 8-14
    CrossrefPubMedSearch in Google Scholar
  • 21 de Oliveira E, Tedeschi H, Siqueira MG. et al. Anatomical and technical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir (Wien) 1996; 138 (01) 1-11 , discussion 11
    CrossrefPubMedSearch in Google Scholar
  • 22 Edner G. One-session operation via bilateral craniotomies for multiple aneurysms after subarachnoid haemorrhage. Br J Neurosurg 1991; 5 (01) 55-60
    CrossrefPubMedSearch in Google Scholar
  • 23 Heiskanen O. Risk of bleeding from unruptured aneurysm in cases with multiple intracranial aneurysms. J Neurosurg 1981; 55 (04) 524-526
    CrossrefPubMedSearch in Google Scholar
  • 24 Vajda J. Multiple intracranial aneurysms: a high risk condition. Acta Neurochir (Wien) 1992; 118 (1-2): 59-75
    CrossrefPubMedSearch in Google Scholar
  • 25 Cervoni L, Delfini R, Santoro A, Cantore G. Multiple intracranial aneurysms: surgical treatment and outcome. Acta Neurochir (Wien) 1993; 124 (2-4): 66-70
    CrossrefPubMedSearch in Google Scholar
  • 26 Inagawa T. Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien) 1991; 108 (1-2): 22-29
    CrossrefPubMedSearch in Google Scholar
  • 27 Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Management outcome for multiple intracranial aneurysms. Neurosurgery 1995; 36 (01) 31-37 , discussion 37–38
    CrossrefPubMedSearch in Google Scholar
  • 28 Orz Y, Osawa M, Tanaka Y, Kyoshima K, Kobayashi S. Surgical outcome for multiple intracranial aneurysms. Acta Neurochir (Wien) 1996; 138 (04) 411-417
    CrossrefPubMedSearch in Google Scholar