Presented at: Congressis 2012, Iasi - First Prize at Surgical Section Also presented at: Medicalis Cluj-Napoca, Romania 2012; Leiden International Medical Students Conference 2013

1. Cristina Caterina Aldea1
Alexandru Durutya2
Ioan Ştefan Florian3
1
4th
year medical student 2
Radiology Clinic Cluj-Napoca 3
Neurosurgery Clinic Cluj-Napoca
“Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

2.  If a patient harbors multiple cerebral
aneurysms, none of them can be deemed
inoffensive1
 Single stage operation with treatment
of all aneurysms is beneficial, sparing the
patient from sequential craniotomies and
anesthesia
 Unilateral approach for bilateral
aneurysms – uncertainty about outcome
Background
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions
1:
T.Hong, Y. Wang : Unilateral Approach to Clip Bilateral Multiple Intracranial Aneurysms.
Surgical Neurology 2009

3. Clarify this uncertainty for the level of the
Neurosurgery Department of the Cluj
County Emergency Hospital
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions
Aim of study

4.  Single center single surgeon retrospective
study
 44 patients with a total of 117 aneurysms
( October 1997- February 2012)
 2 groups – Unilateral aneurysms of the
Anterior Circulation / Bilateral aneurysms
of the Anterior Circulation
 Data was obtained from admission forms
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions
Materials & Methods

5.  Inclusion criteria:
 Hunt & Hess scale < 5
 ASA score < 4
 treated with:
▪ unilateral fronto-pterional approach (on the
side of the ruptured aneurysm)
▪ clipping of all aneurysms
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions

6.  Analyzed data:
 Complication rate:
▪ Hydrocephalus,Vasospasm, Re-bleeding
▪ Infection, Subdural hemorrhage
▪ Correlation with rupture site
 Mortality
 State at discharge (Glasgow Outcome
Scale – GOS)
 Data analysis:
 EpiInfo statistical software
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions

7.  OperativeTechnique:
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions

8.  OperativeTechnique:
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions

9.  OperativeTechnique:
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions

10.  OperativeTechnique:
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions
Early (first 96 hrs
after rupture)
Late (more than 96 hrs
after rupture)

11.  Number of aneurysms per patient:
 Male : Female ratio = 1:3
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions
Results

12.  Localization:
 Most frequent combinations: ACoA – MCA and
ACoA – PCoA
 Mirror-like aneurysms: 6 cases
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions

13. Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions
Unilateral or Bilateral
Chi square value P value
Hunt & Hess scale 0,07 0,7927
ASA score 0,2995 0,5842
Mortality 1,4125 0,2346
Complications 0,0918 0,7619
GOS 0,9219 0,337
! 53% of patients discharged with GOS of 4 (moderately
disabled) and 5 (good recovery)

14. Site Ruptured Compl. Correlation p value
MCA 20 5 0,31 0,127
ICA 6 2 0,46 0,183
ACoA 14 8 0,69 0,042
PCoA 2 0 0 -
ACA 2 1 0,50 1,238
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions
Correlation between rupture site and
complication rate

15.  There are no major differences between
the 2 groups regarding the rate of
complications or the outcome
 None of the rupture sites is correlated
with an increased risk of developing
complications
 ACoA had the highest correlation/statistical
significance
Conclusions
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions

16.  If performed by a skilled neurosurgeon:
fronto-pterional approach with clipping
of all aneurysms, is beneficial for both
unilateral and bilateral multiple cerebral
aneurysms of the anterior circulation
Introduction
Background
Aim
Materials and Methods
Study Design
Operative technique
Results
Number
Localization
Outcome
Conclusions