Clinical Analysis of Surgical and Endovascular Treatment of Unruptured Intracranial Aneurysm

Objective : The purpose of this study was to review factors used to determine whether a patient with an unruptured intracranial aneurysm is treated using surgical therapy or endovascular therapy. Methods : We retrospectively reviewed the records of 68 patients with 74 unruptured intracranial aneurysms who underwent embolization with Guglielmi Detachable Coil (GDC) or surgical occlusion at our institution between April 1990 and December 2005. Surgical clipping was performed in 58 consecutive patients (16 men and 42 women) with 63 unruptured intracranial aneurysms, and endovascular coiling was performed in 10 consecutive patients (4 men and 6 women) with 11 unruptured intracranial aneurysms. There were no standard selection criteria, irrespective of whether the patient was treated with endovascular coil therapy or with neurosurgical clip occlusion. Results : Out of 58 patients who underwent surgical treatment, 3 (5.2%) had fair outcome. Each of these 3 had risk factors for surgical intervention: calcification, wide neck, or thrombosed giant aneurysm. GDC embolization in 1 (10%) patient with an unruptured pericallosal artery aneurysm resulted in a fair outcome due to infarction. Conclusion: Management decisions in patients with unruptured intracranial aneurysms require accurate assessment of the risk factors (such as aneurysm size, location, presence of calcification and/or atheroma, and patient age).