Management of Unruptured Intracranial Aneurysms in Patients with Ischemic Cerebrovascular Disease

허혈성 뇌혈관 질환이 있는 환자에서 비파열성 동맥류의 치료

Objective : Unruptured intracranial aneurysms (UIA) accompanied by ischemic cerebrovascular disease (CVD), will be an increasing problem for neurosurgeons in the future, as the population ages. These patients are a high-risk group of treatment. UIA associated with ischemic CVD in seventeen patients were analyzed and their managements are discussed. Methods : In the past four years, one hundred seventy seven cases of UIAs were treated in our hospital. Among them, seventeen patients suffered from ischemic CVD before treatment of aneurysm. The age of patients varied from 40 to 78 (mean 63.2) years old. The associated ischemic CVD was that transient ischemic attack (TIA) was nine, minor completed stroke in eight patients. There was permanent neurological deficit in two patients. Microsurgical treatment underwent for ten patients and seven patients were treated with endovascular technique. Results : Fourteen patients were fully recovered from surgical and endovascular management. In clipping group, hemiparesis event occurred in one patient after the surgery. The patient suffered from ischemia-related permanent neurological worsening. There were two patients who developed neurological deficit following endovascular treatment for UIA in seven patients of coiling group. One patient was recovered after rehabilitation but the other patient didn' improve left hemiparesis until discharge. This patient had bilateral paraclinoid aneurysms. We treated these lesions simultaneously and coil embolization for the aneurysm was uneventful. However, left side weakness developed after the procedure. Angiography revealed occlusion of cortical branches of middle cerebral artery and MRI scan showed hyperintense areas in the right motor cortex. Conclusion : Our results suggest that surgical treatment of unruptured cerebral aneurysm is not contraindicated in patients with CVD. However, the treatment of UIA accompanied by CVD should be performed only after careful examination of the factors involved in the particular ischemic episodes. Careful case selection and perioperative management are mandatory for preventing surgical complications.