Cristina Caterina Aldea1 Alexandru Durutya2 Ioan Ştefan Florian3

14th year medical student 2Radiology Clinic Cluj-Napoca 3Neurosurgery Clinic Cluj-Napoca

“Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

If a patient harbors multiple cerebral aneurysms, none of them can be deemed inoffensive1

Single stage operation with treatment of all aneurysms is beneficial, sparing the

patient from sequential craniotomies and anesthesia

Unilateral approach for bilateral aneurysms – uncertainty about outcome

BackgroundIntroduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

1: T.Hong, Y. Wang : Unilateral Approach to Clip Bilateral Multiple Intracranial Aneurysms. Surgical Neurology 2009

Clarify this uncertainty for the level of the Neurosurgery Department of the Cluj

County Emergency Hospital

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Aim of study

Single center single surgeon retrospective study

44 patients with a total of 117 aneurysms ( October 1997- February 2012)

2 groups – Unilateral aneurysms of the Anterior Circulation / Bilateral aneurysms of the Anterior Circulation

Data was obtained from admission forms

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Materials & Methods

Inclusion criteria: Hunt & Hess scale < 5 ASA score < 4 treated with:▪ unilateral fronto-pterional approach (on the

side of the ruptured aneurysm)▪ clipping of all aneurysms

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Analyzed data: Complication rate:▪ Hydrocephalus, Vasospasm, Re-bleeding▪ Infection, Subdural hemorrhage▪ Correlation with rupture site

Mortality State at discharge (Glasgow Outcome

Scale – GOS)

Data analysis: EpiInfo statistical software

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Operative Technique:Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Operative Technique:Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Operative Technique:Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Operative Technique:Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Early (first 96 hrs after rupture)

Late (more than 96 hrs after rupture)

Number of aneurysms per patient:

Male : Female ratio = 1:3

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Results

Localization:

Most frequent combinations: ACoA – MCA and ACoA – PCoA

Mirror-like aneurysms: 6 cases

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Unilateral or Bilateral

Chi square value P value

Hunt & Hess scale 0,07 0,7927

ASA score 0,2995 0,5842

Mortality 1,4125 0,2346

Complications 0,0918 0,7619

GOS 0,9219 0,337

! 53% of patients discharged with GOS of 4 (moderately disabled) and 5 (good recovery)

Site Ruptured Compl. Correlation p value

MCA 20 5 0,31 0,127

ICA 6 2 0,46 0,183

ACoA 14 8 0,69 0,042

PCoA 2 0 0 -

ACA 2 1 0,50 1,238

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

Correlation between rupture site and complication rate

There are no major differences between the 2 groups regarding the rate of complications or the outcome

None of the rupture sites is correlated with an increased risk of developing complications ACoA had the highest correlation/statistical

significance

ConclusionsIntroduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions

If performed by a skilled neurosurgeon: fronto-pterional approach with clipping

of all aneurysms, is beneficial for both unilateral and bilateral multiple cerebral aneurysms of the anterior circulation

Introduction Background Aim

Materials and Methods Study Design Operative technique

Results Number Localization Outcome

Conclusions