Surgical treatment of bilateral multiple intracranial aneurysms. Review of a personal experience in 69 cases

AIM: There has been much controversy concerning the surgical treatment of bilateral multiple intracranial aneurysms. Some authors advocate the use of two-stage surgery by bilateral pterional craniotomies and others advocate the one stage complete repair of all lesions using the contralateral approach. We analyze the surgical experience of one neurosurgeon using both approaches. METHODS: Sixty nine patients operated on for bilateral multiple intracranial aneurysms were divided in three groups: group A comprised 43 patients (62.3%) in whom all bilateral aneurysms were treated by one stage operation; group B comprised 9 patients (13.0%) in whom the clipping of the contralateral aneurysm it was not possible through the same approach, needing a second operation; group C comprised 17 patients (24.7%) in whom all bilateral multiple intracranial aneurysms were treated by two stage operations. RESULTS: According to the Glasgow Outcome Scale 61 cases (88.4%) had excellent or good results (GOS V, IV), 2 cases (2.9%) had fair results (GOS III) and 6 patients have died (GOS I). The results of group A were significantly better than in-group B (p<0,05 Fisher test), but they were not different in relation to the group C (p=0,439 Fisher test). Among the six deaths, only one was related to the surgical procedure. CONCLUSIONS: Under favorable clinical situations, as patients in H&H I to III, good brain conditions during the surgical procedure and aneurysms smaller than 1,5 cm, the contralateral surgical approach for the treatment of patients with bilateral multiple intracranial aneurysms can be used with advantages over the two stage approach.