The Second-Set Surgeries for Multiple Unruptured Aneurysms Do Not Increase Perioperative Complications.

Background and objectives: Intracranial aneurysms affect 3% to 4% of the population, with 20% to 25% having multiple aneurysms. Aggressive treatment is warranted for multiple unruptured aneurysms because of their higher risk of rupture and enlargement compared with single aneurysms. However, the risks and appropriate timing of secondary clipping surgeries are underreported. We assessed the prognosis and risks of treating multiple cerebral aneurysms with a second surgery and determined the differences in prognosis based on the timing of these surgeries.

Methods: We retrospectively reviewed patients who underwent secondary clipping surgery for multiple unruptured cerebral aneurysms at our hospital and affiliated institutions. The number, size, and location of aneurysms, patient demographics, and antithrombotic drug history were compared between the first and second surgeries. The modified Rankin Scale score and postoperative complications, including ischemia, hemorrhage, seizures, chronic subdural hematoma requiring surgery, infection, and postoperative hospital days, were investigated.

Results: A total of 38 patients (mean age, 65 years) were included. No significant differences were observed in modified Rankin Scale score worsening, postoperative hospital stay, or complication rates between the 2 surgeries. Older patients tended to undergo the second surgery within 6 months, with no significant difference in complication rates. The first surgery targeted larger aneurysms.

Conclusion: The absence of complications between surgeries and the absence of rupture or re-treatment during follow-up emphasize the importance of choosing the most appropriate approach for each aneurysm. The first and second surgeries for multiple cerebral aneurysms did not significantly affect postoperative complications. Performing 2 craniotomies may facilitate the curative and safe treatment of aneurysms.