The incidence and treatment of asymptomatic, unruptured cerebral aneurysms

Toshio Nakagawa M.D. 1 and Kazuo Hashi M.D., D.M.Sc. 1
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  • 1 Division of Neurosurgery, Shinsapporo Neurosurgical Hospital, and Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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✓ The importance of early detection by various radiological techniques of asymptomatic, unruptured aneurysms as a means of preventing subarachnoid hemorrhage (SAH) is discussed in this report. Four hundred volunteers underwent clinical and radiological evaluations between March, 1988, and September, 1992. Studies included a neurological examination as well as digital subtraction cerebral angiography via a femoral arterial catheter, computerized tomography, T1- and T2-weighted magnetic resonance (MR) imaging of the whole brain, and MR angiography. The evaluation revealed 27 asymptomatic, unruptured intracranial aneurysms in 26 volunteers, for an incidence of 6.5%. The subjects ranged in age from 39 to 71 years, with an average of 55 years. The aneurysms were located on the internal carotid artery in 13 cases (48%), the anterior communicating artery in six (22%), the middle cerebral artery in six (22%), and the basilar artery in two (7%). Aneurysms ranged in size from 5 mm or less in 16 cases, 6 to 10 mm in nine, and 11 to 15 mm in one; one aneurysm was more than 15 mm, with a maximum diameter of 2 cm. Volunteers with a family history of SAH within the second degree of consanguinity showed a higher incidence of aneurysms (17.9%). Aneurysm clipping was performed on 20 of the 26 cases with no significant morbidity or mortality. These findings support the contention that aggressive early detection of unruptured aneurysms may improve the outcome in patients harboring cerebral aneurysms by preventing the devastating effects of SAH.

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Contributor Notes

Address for Dr. Hashi: Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.

Address reprint requests to: Toshio Nakagawa, M.D., Division of Neurosurgery, Shinsapporo Neurosurgical Hospital, 1–10, 1-jo, 2-chome, Kaminopporo Atsubetsu-ku, Sapporo, Japan.
  • 1.

    Atkinson JLD, , Sundt TM Jr, & Houser OW, et al: Angiographic frequency of anterior circulation intracranial aneurysms. J Neurosurg 70:551555, 1989 Atkinson JLD, Sundt TM Jr, Houser OW, et al: Angiographic frequency of anterior circulation intracranial aneurysms. J Neurosurg 70:551–555, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Drake CG: Management of cerebral aneurysm. Stroke 12:273283, 1981 Drake CG: Management of cerebral aneurysm. Stroke 12: 273–283, 1981

    • Search Google Scholar
    • Export Citation
  • 3.

    Drake CG, & Girvin JP: The surgical treatment of subarachnoid hemorrhage with multiple aneurysms, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 274278 Drake CG, Girvin JP: The surgical treatment of subarachnoid hemorrhage with multiple aneurysms, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia: WB Saunders, 1976, pp 274–278

    • Search Google Scholar
    • Export Citation
  • 4.

    Heiskanen O: Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55:524526, 1981 Heiskanen O: Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 55:524–526, 1981

    • Search Google Scholar
    • Export Citation
  • 5.

    Heiskanen O: Risk of surgery for unruptured intracranial aneurysms. J Neurosurg 65:451453, 1986 Heiskanen O: Risk of surgery for unruptured intracranial aneurysms. J Neurosurg 65:451–453, 1986

    • Search Google Scholar
    • Export Citation
  • 6.

    Jane JA, , Kassell NF, & Torner JC, et al: The natural history of aneurysms and arteriovenous malformations. J Neurosurg 62:321323, 1985 Jane JA, Kassell NF, Torner JC, et al: The natural history of aneurysms and arteriovenous malformations. J Neurosurg 62:321–323, 1985

    • Search Google Scholar
    • Export Citation
  • 7.

    Kassell NF, , Torner JC, & Haley EC Jr, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:1836, 1990 Kassell NF, Torner JC, Haley EC Jr, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18–36, 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    Kassell NF, , Torner JC, & Jane JA, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 73:3747, 1990 Kassell NF, Torner JC, Jane JA, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 73:37–47, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Lozano AM, & LeBlanc R: Familial intracranial aneurysms. J Neurosurg 66:522528, 1987 Lozano AM, LeBlanc R: Familial intracranial aneurysms. J Neurosurg 66:522–528, 1987

    • Search Google Scholar
    • Export Citation
  • 10.

    McCormick WF: The natural history of intracranial saccular aneurysms. Weekly Update Neurol Neurosurg 3:18, 1978 McCormick WF: The natural history of intracranial saccular aneurysms. Weekly Update Neurol Neurosurg 3:1–8, 1978

    • Search Google Scholar
    • Export Citation
  • 11.

    McCormick WF, & Acosta-Rua GJ: The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 33:422427, 1970 McCormick WF, Acosta-Rua GJ: The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 33:422–427, 1970

    • Search Google Scholar
    • Export Citation
  • 12.

    Moyes PD: Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 35:291295, 1971 Moyes PD: Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 35:291–295, 1971

    • Search Google Scholar
    • Export Citation
  • 13.

    Nagashima M, , Nemoto M, & Hadeishi H, et al: [Surgical treatment of unruptured aneurysms associated with ischemic cerebrovascular disease.] No Socchuu No Geka 16:219223, 1988 (Jpn) Nagashima M, Nemoto M, Hadeishi H, et al: [Surgical treatment of unruptured aneurysms associated with ischemic cerebrovascular disease.] No Socchuu No Geka 16:219–223, 1988 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 14.

    Norrgård Ö, , Ängquist KA, & Fodstad H, et al: Intracranial aneurysms and heredity. Neurosurgery 20:236239, 1987 Norrgård Ö, Ängquist KA, Fodstad H, et al: Intracranial aneurysms and heredity. Neurosurgery 20:236–239, 1987

    • Search Google Scholar
    • Export Citation
  • 15.

    Phillips LH II, , Whisnant JP, & O'Fallon WM, et al: The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 30:10341040, 1980 Phillips LH II, Whisnant JP, O'Fallon WM, et al: The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 30:1034–1040, 1980

    • Search Google Scholar
    • Export Citation
  • 16.

    Pia HW, , Obrador S, & Martin JG: Association of brain tumours and arterial intracranial aneurysms. Acta Neurochir 27:189204, 1972 Pia HW, Obrador S, Martin JG: Association of brain tumours and arterial intracranial aneurysms. Acta Neurochir 27:189–204, 1972

    • Search Google Scholar
    • Export Citation
  • 17.

    Rice BJ, , Peerless SJ, & Drake CG: Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg 73:165173, 1990 Rice BJ, Peerless SJ, Drake CG: Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg 73:165–173, 1990

    • Search Google Scholar
    • Export Citation
  • 18.

    Salazar JL: Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 53:2021, 1980 Salazar JL: Surgical treatment of asymptomatic and incidental intracranial aneurysms. J Neurosurg 53:20–21, 1980

    • Search Google Scholar
    • Export Citation
  • 19.

    Samson DS, , Hodosh RM, & Clark WK: Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46:731734, 1977 Samson DS, Hodosh RM, Clark WK: Surgical management of unruptured asymptomatic aneurysms. J Neurosurg 46:731–734, 1977

    • Search Google Scholar
    • Export Citation
  • 20.

    Schievink WI, , Limburg M, & Dreissen JJR, et al: Screening for unruptured familial intracranial aneurysms: subarachnoid hemorrhage 2 years after angiography negative for aneurysms. Neurosurgery 29:434438, 1991 Schievink WI, Limburg M, Dreissen JJR, et al: Screening for unruptured familial intracranial aneurysms: subarachnoid hemorrhage 2 years after angiography negative for aneurysms. Neurosurgery 29:434–438, 1991

    • Search Google Scholar
    • Export Citation
  • 21.

    Sekhar LN, & Heros RC: Origin, growth, and rupture of saccular aneurysms: a review. Neurosurgery 8:248260, 1981 Sekhar LN, Heros RC: Origin, growth, and rupture of saccular aneurysms: a review. Neurosurgery 8:248–260, 1981

    • Search Google Scholar
    • Export Citation
  • 22.

    ter Berg HWM, , Dippel DWJ, & Habbema JDF, et al: Treatment of intact familial intracranial aneurysms: a decisionanalytical approach. Neurosurgery 23:329334, 1988 ter Berg HWM, Dippel DWJ, Habbema JDF, et al: Treatment of intact familial intracranial aneurysms: a decisionanalytical approach. Neurosurgery 23:329–334, 1988

    • Search Google Scholar
    • Export Citation
  • 23.

    Wakai S, , Fukushima T, & Furihata T, et al: Association of cerebral aneurysm with pituitary adenoma. Surg Neurol 12:503507, 1979 Wakai S, Fukushima T, Furihata T, et al: Association of cerebral aneurysm with pituitary adenoma. Surg Neurol 12:503–507, 1979

    • Search Google Scholar
    • Export Citation
  • 24.

    Winn HR, , Almaani WS, & Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642651, 1983 Winn HR, Almaani WS, Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642–651, 1983

    • Search Google Scholar
    • Export Citation
  • 25.

    Winn HR, , Richardson AE, & O'Brien W, et al: Long-term prognosis in untreated cerebral aneurysms: II. Late morbidity and mortality. Ann Neurol 4:418426, 1978 Winn HR, Richardson AE, O'Brien W, et al: Long-term prognosis in untreated cerebral aneurysms: II. Late morbidity and mortality. Ann Neurol 4:418–426, 1978

    • Search Google Scholar
    • Export Citation
  • 26.

    Wirth FP, , Laws ER Jr, & Piepgras D, et al: Surgical treatment of incidental intracranial aneurysms. Neurosurgery 12:507511, 1983 Wirth FP, Laws ER Jr, Piepgras D, et al: Surgical treatment of incidental intracranial aneurysms. Neurosurgery 12:507–511, 1983

    • Search Google Scholar
    • Export Citation

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