Treatment Of Multiple Intracranial Aneurysms Research Articles

Endovascular treatment of multiple intracranial aneurysms.

Multiple intracranial aneurysms are difficult to treat. In order to investigate the effect and safety of endovascular treatment for multiple intracranial aneurysms, 54 consecutive patients with 116 multiple intracranial aneurysms treated with endovascular embolization were retrospectively enrolled. Angiography was performed immediately after embolization and at each follow-up. All clinical data were analyzed. Of the 116 aneurysms, 56 (48.3%) were embolized with coiling alone, 19 (16.4%) with stent-assisted coiling, 31 (26.7%) with stenting alone, and 10 (8.6%) with flow diverters plus coiling. After embolization, 31 (27.6%) aneurysms with stenting alone had no apparent change in size, and in the remaining 84 aneurysms, complete occlusion was achieved in 50 aneurysms (59.5%), near-complete occlusion in 26 (31.0%), and incomplete occlusion in 8 (9.5%). Thrombus formation at the aneurysm neck occurred in 3 patients (5.6%), coil protrusion in 2 (3.7%), and intraprocedural rupture in 1 (1.9%), resulting in a total complication rate of 11.1%. Follow-up angiography was performed in 44 (81.5%) patients 6 to 90 months (mean 49) later. Among 50 completely occluded aneurysms, 38 (76%) aneurysms remained completely occluded, and 4 (8%) aneurysms recurred. Among 26 aneurysms with initial near-complete occlusion, 12 (46.2%) aneurysms with neck remnant had progressive thrombosis to complete occlusion, 2 (7.7%) had no change compared with immediate occlusion, and 5 (19.2%) regrew. In conclusion, endovascular embolization with intracranial stenting and coiling is safe and effective and may play an increasingly important role in the management of multiple intracranial aneurysms.

Single-stage endovascular treatment in aneurysmal subarachnoid haemorrhage with multiple intracranial aneurysms: Systematic review of the literature and multicentric retrospective experience.

The presence of multiple intracranial aneurysms in patients with acute subarachnoid haemorrhage is a condition with no evidence of optimal treatment strategy, especially in case of uncertain haemorrhage patterns on cumputed tomography. The aim of this study was to analyse the safety and efficacy profile of single-stage endovascular treatment of multiple intracranial aneurysms with aneurysmal subarachnoid haemorrhage in the literature and in a retrospective case series. A systematic review of the present literature was conducted to identify studies related to single-stage endovascular treatment for ≥2 aneurysms; in addition, a retrospective multicentric review was performed. Data on clinical presentation, aneurysm size and location, occlusion rates, intracranial complications and clinical outcome were recorded. Thirteen articles were identified (all little case series) reporting 189 patients harbouring 389 aneurysms. And 85.6% presented with a Hunt-Hess scale 1-3, and 14.4% 4-5. Intracranial complications rate was 11.5%. Baseline and follow-up (20.5 months) occlusion rates were adequate (Raymond-Roy occlusion scale I-II) in 93% and 96.2%, respectively. 81% of patients had favourable clinical outcomes (modified Rankin Scale (mRS) ≤2; Glasgow outcome scale (GOS) 5-4) and 19% poor (mRS 3-6; GOS 3-1). The retrospective database identified 53 patients with 115 aneurysms. Clinical presentation was Hunt-Hess (HH) 1-3/WNFS 1-2 75% and HH 4-5/WNFS 3-5 25%. Intracranial complication rate was 24.5%. Occlusion rate RROC I-II was 78.7% at baseline and 15 months and 90.2% at follow up. Clinical outcome at 3 months was mRS ≤2 68.6% and mRS 3-6 31.4%. Single-staged endovascular treatment can be feasible, although a higher risk of intraprocedural complications, with clinical presentation being the major factor to influence the outcome.

Endovascular treatment of multiple intracranial aneurysms in patients with subarachnoid hemorrhage: one or multiple sessions?

This study aimed to compare the safety and efficacy of single- and multiple-stage endovascular treatment in aneurysmal subarachnoid hemorrhage (SAH) patients with multiple intracranial aneurysms. We retrospectively analyzed the clinical and imaging data of 61 patients who harbored multiple aneurysms and presented to our institution with aneurysmal subarachnoid hemorrhage. Patients were grouped according to endovascular treatment strategy: one-stage or multiple-stage. The 61 study patients harbored 136 aneurysms. One aneurysm in each patient had ruptured. In the one-stage treatment group, all 66 aneurysms in 31 patients were treated in one session. The mean follow-up was 25.8 months (range, 12-47). At the last follow-up, the modified Rankin scale was ≤2 in 27 patients. In total, 10 complications occurred (cerebral vasospasm, six patients; cerebral hemorrhage, two patients; and thromboembolism, two patients). In the multiple-stage treatment group, only the ruptured aneurysm (30 in total) was treated at the time of presentation, and the remaining aneurysms (40 in total) were treated later. The mean follow-up was 26.3 months (range, 7-49). At the last follow-up, the modified Rankin scale score was ≤2 in 28 patients. In total, five complications occurred (cerebral vasospasm, four patients; and subarachnoid hemorrhage, one patient). During the follow-up period, there was one recurrence of aneurysm with subarachnoid hemorrhage in the single-stage treatment group and four recurrences in the multiple-stage treatment group. Both single- and multiple-stage endovascular treatment is safe and effective in aneurysmal subarachnoid hemorrhage patients who harbor multiple aneurysms. However, multiple-stage treatment is associated with a lower rate of hemorrhagic and ischemic complications.

Simultaneous Craniotomies for Multiple Intracranial Aneurysm Clippings—One-Stage Surgery with Multiple Craniotomies

The treatment of multiple intracranial aneurysms (MIAs) involves various modalities and sometimes requires staged operations. This study aimed to prove the efficacy and safety of one-stage multiple craniotomies (OSMC) for multiple cerebral aneurysms. We retrospectively reviewed the medical records of the patients who underwent treatment for intracranial aneurysms between May 2003 and April 2020. The surgical results, complications, and lengths of hospital stay were compared between the patients who underwent OSMC and those who underwent multistage multiple craniotomies. The demographic characteristics of the OSMC and multistage multiple craniotomies groups (n= 82 and 43, respectively) were similar. There were no statistically significant differences between the 2 groups when the amount of blood transfused, complications, and surgical results were compared (P= n.s. for all); however, the operation time and hospitalization period (353.9 minutes vs. 490.3 minutes and 12.3 days vs. 21.8 days, respectively; P= 0.001 for both) were shorter in the OSMC group. The treatment cost (17,000 USD vs. 22,000 USD, P= 0.001) was lower in the OSMC group. OSMC for aneurysm clipping in patients with MIAs is a relatively safe and economical method. Furthermore, it has good clinical outcomes. This new surgical method is worthwhile in that it can be applied to patients who are afraid to undergo multiple surgeries, and we suggest that it is an efficient, low-cost option for the treatment of MIAs.

HYBRID MICROSURGICAL AND ENDOVASCULAR APPROACH IN THE TREATMENT OF MULTIPLE CEREBRAL ANEURYSMS: AN ILLUSTRATIVE CASE SERIES IN CORRELATION WITH LITERATURE DATA.

SUMMARYContemporary cerebral aneurysm treatment has advanced due to the expansion of microsurgical and endovascular techniques having different advantages and restraints. However, some aneurysms cannot be effectively treated by a single method alone due to their specific anatomy, location, complexity, and/or multiplicity. Subsequently, multiple aneurysms sometimes necessitate a hybrid strategy integrating both methods. The study aims were to discuss indications, possibilities, and challenges of a hybrid strategy in the decision making and treatment of multiple intracranial aneurysms. A single-institution illustrative case series of multiple intracranial aneurysm patients treated by a hybrid approach was analyzed and management outcome discussed and correlated with literature data. Following the treatment, both patients from our case series recovered well, having complete and stable aneurysmal occlusion with no relapse and no postoperative procedure-related complications or long-lasting neurological symptoms. In conclusion, a hybrid approach is advised as a treatment option for multiple cerebral aneurysms when a single modality is insufficient to bring satisfactory results. It may be a suitable and safe addition to an assortment of treatments pledging clinical improvement and enabling positive management outcome in patients with ruptured and non-ruptured multiple cerebral aneurysms.

Late results and health-related quality of life in patients after endovascular treatment for multiple intracranial aneurysms

Aim. To assess the results of endovascular treatment in patients with multiple intracranial aneurysms (MIA) in the late postoperative period according to health-related quality of life (HRQoL) concept. Materials and methods . 172 cases of patients having undergone endovascular MIA repair were examined. The evaluation of patient health-related quality of life was carried out using the SF-36 (The Short Form ( 36 ) Health Survey), the ICF (the International Classification of Functioning), and the modified Rankin Scale (mRS). Results . The complication of subarachnoid hemorrhage ( SAH ) appears in approximately 1,2% of cases in the late postoperative period. When assessing the health-related quality of life according to the SF-36 domains in patients with Subarachnoid hemorrhage (SAH), the QoL showed a decrease in “Social Functioning” ( p = 0.03) . In patients with pseudotumor cerebri (PTC) a decrease was seen in “ Role-Physical Functioning” (RP) ( p = 0.004), while “General Health” (GH) ( p = 0.049), “Social Functioning” (SF) ( p = 0.005) and “Mental Health” (MH) ( p = 0.009) subscales also saw decreases. Having more than two inpatient surgical procedures is also associated with the health-related quality of life of patients ( p < 0.05). Assessment of activity with ICF showed the intensity of irregularities on the d4501 domain – “walking short distance” – depended on the existing SAH ( p < 0.05). Procedural complications affected the patient’s daily activities on the domains d4501 — “walking long distance” ( p = 0.03), and d640 — “doing household chores” ( p = 0.01). Conclusion . The assessment with ICF allows the specification of patient activity and participation in public life. The SF-36 scale provides additional information on the patients’ subjective perception of their condition. Considering the quality of life in the late postoperative period is not completely restored in all patients, ongoing rehabilitation measures, diagnostic cerebral angiographies and improvements in the surgery techniques are required.

Hemodynamic Changes in the Treatment of Multiple Intracranial Aneurysms: A Computational Fluid Dynamics Study

Intracranial aneurysm rupture is associated with a high mortality and disability despite modern medical care. Multiple aneurysms occur in nearly 16% of patients, and imaging studies of naturally occurring multiple aneurysms are valuable for computational fluid dynamics studies. In this study, we describe and analyze the hemodynamic changes produced in a distal aneurysm after the treatment of a proximal aneurysm. Between January 2008 and December 2017, 24 cases of multiple intracranial aneurysms of the same vascular tree were treated in our center. Full carotid segmentations from digital subtraction angiography, computed tomography angiography, or magnetic resonance angiography were obtained, and transient pulsatile simulations were performed using computational fluid dynamics software. Output variables included maximum peak systole wall shear stress (WSS), minimum mid-diastolic WSS, maximum systolic pressure, low shear area, and high shear area both before and after treatment of the proximal aneurysm. The mean size of ruptured and unruptured aneurysms was 7.05 and 5.23 mm, respectively (P= 0.035), with respective aspect ratios of 1.22 and 2.04 (P= 0.001). Maximum peak systole WSS was lower and minimum mid-diastolic WSS was higher in unruptured aneurysms (P=0.04 and 0.034, respectively). After treatment of the proximal aneurysm, low shear area in the distal aneurysm increased from 54.15% to 56.93% (P= 0.02). The opposite effect is noted in aneurysms with an interaneurysmal distance <10 mm. Posttreatment peak systole pressure was also increased significantly (P= 0.03). The hemodynamic changes in a distal aneurysm after treatment of a proximal aneurysm showed an unfavorable profile associated with an increased theoretical risk of bleeding.

Treatment of Multiple Intracranial Aneurysms with 1-stage Clipping

Treatment of Multiple Intracranial Aneurysms with 1-stage Clipping

Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?

Background and purposeMultiple aneurysms have a high reported incidence, but the optimal treatment strategy is not clear. The aim of this study was to evaluate the safety and effectiveness of...

Seven Cerebral Aneurysms: A Challenging Case from the Andean Slopes Managed with 1-Stage Surgery

Treatment of multiple intracranial aneurysms is particularly demanding and even more so in a developing country where access to specialized centers may be prevented by different factors. Single-stage surgical treatment of 7 cerebral aneurysms was performed in a 58-year-old woman from the northern Peruvian Andes. All 7 aneurysms were successfully and safely clipped through 2 lateral supraorbital craniotomies. The double clip technique was used in 3 aneurysms to prevent any residual aneurysmal neck. Good teamwork and correct application of microsurgical principles may allow effective treatment in complex neurosurgical cases even in resource-challenged environments.

One-Stage Endovascular Embolization for Multiple Intracranial Aneurysms.

Clinical treatment of multiple intracranial aneurysms remains challenging due its higher rate of rupture compared to a single aneurysm. We aimed to assess the efficacy of one-stage endovascular embolization for treatment of multiple intracranial aneurysms. We treated 72 aneurysms from 33 patients with one-stage endovascular embolization from September 2010 to October 2015. Of these, 60 aneurysms were treated with coils, while 12 wide-neck aneurysms were embolized with the assistance of intracranial stents. Follow-up studies ranged from 3 to 28 months, and patient outcomes were assessed using the modified Rankin Scale (mRS) and digital subtraction angiography (DSA). All aneurysms were embolized successfully and no complications occurred. DSA immediately after procedure revealed that complete occlusion was achieved in 39 cases, neck remnant was observed in 27 cases, and a residual aneurysm remnant was observed in six cases. All patients achieved excellent clinical outcomes following embolization (27 patients with a mRS score of 0 and 6 with a mRS score of 1). Six months after the procedure, DSA was performed on 28 patients, revealing one case with a neck remnant, and two cases with completely occluded aneurysms. Despite these outcomes, there was no rupture or hemorrhage of these aneurysms throughout the six months. One-stage endovascular embolization is a safe and effective treatment for multiple intracranial aneurysms, but long-term outcomes should be further evaluated.

Surgical treatment of multiple intracranial aneurysms

To discuss the surgical strategies and analyze the clinical outcomes of multiple intracranial aneurysms (MIA). The clinical data of 49 MIA patients surgically treated between January 2009 and December 2013 was analyzed retrospectively. Among the 49 patients, 12 patients were male and 37 were female, mean age (49 ± 11) years. Thirty-five patients had ruptured aneurysms, and 14 had unruptured aneurysms. Treatment strategies included one-stage operation (MIA were treated in one-stage with an unilateral approach), two-stage treatment (MIA were treated stage by stage) and partial treatment (only ruptured aneurysm was treated). Postoperative CT angiograms (CTA) or digital subtraction angiograms (DSA) were reviewed and the Glasgow Outcome Scale (GOS) scores were evaluated during follow-up period. Thirty-two patients (65.3%) underwent one-stage operation, 9 patients (18.4%) underwent two-stage treatment, and 8 patients (16.3%) underwent partial treatment. Forty-seven patients were followed up 4-49 months, mean (22 ± 7) months. Postoperative CTA or DSA showed no aneurysm recurrence. According to the GOS scores, 41 patients (83.7%) with good outcomes (GOS 4, 5), 6 patients (12.2%) were disabled (GOS 2, 3) and 2 patients (4.1%) were dead (GOS 1). Selecting the right patients for surgery and making personalized surgical strategies based on the characteristics of patients and aneurysms could improve the surgical outcomes of MIA.

Treatment of Multiple Intracranial Aneurysms with 1-Stage Coiling

Although multiple intracranial aneurysms are frequent, determining treatment strategy and methods for them is often complicated. The aim of this study was to evaluate the safety and effectiveness of 1-stage coiling for multiple intracranial aneurysms. All patients who underwent 1-stage coiling for ≥2 aneurysms were identified from a prospectively registered neurointerventional data base during 10 years. The patient characteristics and clinical and angiographic outcomes at discharge and follow-up were retrospectively evaluated. One hundred sixty-seven patients (male/female ratio, 30:137; mean age, 58 years) with multiple aneurysms (418 aneurysms; mean, 2.5 aneurysms/patient) underwent attempted 1-stage coiling for ≥2 aneurysms (359 aneurysms; mean, 2.1 aneurysms/patient). In 131 patients (78.4%), all detected aneurysms were treated with coiling only. Treatment-related morbidity and mortality at discharge were 1.8% and 0.6% per patient, respectively. Of the 132 patients without subarachnoid hemorrhage, 129 (97.7%) had favorable outcomes (mRS 0-2) at discharge; of the 35 patients with SAH, 27 (77.1%) had favorable outcomes at discharge. Of the 162 patients (97%) for whom clinical follow-up was available (mean, 35.8 months), 154 patients (95.1%) had favorable outcomes. Immediate posttreatment angiography showed complete occlusion in 186 (51.8%) aneurysms, neck remnants in 134 (37.3%), sac remnants in 33 (9.2%), and failure in 6 (1.7%). Of the 262 (73.9%) aneurysms that underwent follow-up imaging (mean, 24.8 months), 244 (93.1%) showed a stable or improved state, with 12 (4.6%) minor and 6 (2.3%) major recurrences. One-stage coiling of multiple aneurysms seems to be safe and effective, with low morbidity and mortality.

Surgical treatment of multiple intracranial aneurysms.

To discuss the surgical methods for multiple intracranial aneurysms. 23 patients were divided into three groups according to the location of the aneurysms: aneurysms located in one side or in the midline of the Willis ring; aneurysms located on both sides of the Willis ring with unruptured aneurysms located ahead of the middle cerebral artery bifurcation; and MIAs located on both sides with unruptured aneurysms located in the middle cerebral artery bifurcation or distal bifurcation. The preoperative operation strategy was made according to different groups. All patients in the first group underwent a one-stage operation for occlusion of all aneurysms. In the second group, eight patients underwent a one-stage operation for occlusion of all arterial aneurysms while the other three patients underwent a one-stage operation for occlusion of the ipsilateral aneurysms, followed by a two-stage operation for occlusion of the contralateral arterial aneurysms. In the third group, all patients underwent a two-stage operation for occlusion of all aneurysms. Good recovery, moderate disability, and severe disability were observed in 19, 2, and 2 cases, respectively. One-stage or two-stage surgery was determined based on the distribution of multiple aneurysms and the intraoperative situation to achieve ideal treatment effects.

Endovascular treatment of multiipie intracranial aneurysms

Objective To evaluate the results of endovascular embolization of multiple intracranial aneurysms.Methods A retrospective hospital chart and radiograph review were performed of all patients with multiple intracranial aneurysms between March 2010 and January 2011.Results Ten patients presented with subarachnoid hemorrhage (SAH),four mass effects,two brain ischemia and twenty were incidental.These 36 patients harbored 84 aneurysms,63 of which were treated with endovascular techniques,two by surgical clipping,and nineteen were left untreated.In the coil-treated lesions,a complete endovascular occlusion was achieved in 54 aneurysms (86％),and 8 (13％) presented neck remnants with one (2％) stented only.Twenty-six patients (72％) underwent coil embolization of more than one aneurysm in the first session.Follow-up angiographic studies in 31 patients demonstrated an unchanged or improved result in 93％ of the aneurysms (53 lesions) and coil compaction in 7％ (four lesions).The overall clinical outcome was excellent in 33 patients (92％),good in one (3％) and fair in two (6％).Conclusions Endovascular techniques may be a particularly suitable method for the treatment of multiple intracranial aneurysms. Key words: Multiple; Aneurysm; Embolization; Intracranial; Coils

Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm?

As many as 33% of patients suffering from subarachnoid hemorrhage (SAH) present with multiple intracranial aneurysms (MIAs). It is believed that aneurysm surgery has the potential to increase the risk of cerebral vasospasm due to surgical manipulations of the parent vessels and brain tissue. Consequently, 1-stage surgery of MIAs, which usually takes longer and requires more manipulation, could even further increase the risk of vasospasm. The aim of this study is to define the correlation between vasospasm and the operative treatment of single intracranial aneurysms versus MIAs in a 1-stage operation. The authors analyzed a database including 1016 patients with SAH, identified retrospectively between 1989 and 1996 and prospectively collected between 1997 and 2004. Exclusion criteria were endovascular treatment, surgery after SAH Day 3, and, in patients with MIAs, undergoing more than 1 operation. Cerebral vasospasm was diagnosed by transcranial Doppler (TCD) ultrasonography and was defined as a maximum mean blood flow velocity > 120 cm/second. The diagnosis of symptomatic vasospasm was made if a new neurological deficit occurred that could not be explained by concomitant complications. A total of 643 patients who experienced 810 aneurysms were included. Four hundred twenty-four patients were female (65.9%) and 219 were male (34.1%) with an average age of 53.1 years. One hundred twenty-one patients (18.8%) were diagnosed with MIAs. Maximum mean flow velocities measured by TCD were 131 cm/second in patients with MIAs and 129.5 cm/second in patients with single intracranial aneurysms. The incidence of TCD vasospasm (p = 0.561) as well as of symptomatic vasospasm (p = 0.241) was not significantly different in the 2 groups. Clipping of more than 1 aneurysm in a 1-stage operation within 72 hours after SAH can be performed without increasing the risk of cerebral (TCD) vasospasm and symptomatic vasospasm.

Microsurgical treatment of multiple intracranial aneurysms

Objective To study the surgical timing and strategy as well as relative factors with surgical outcome through 18 cases of multiple intracranial aneurysms (MIA). Methods The clinical datas of 18 cases with 44 aneurysms who underwent microsurgical operation were analyzed retrospectively. The MIA were treated through the method of combining early - stage with select - stage operation and one - stage with two - stage operation. The operating principle was that the ruptured aneurysm was performd operation at first. Results Thirty -nine aneurysms were clipped directly, two aneurysms were wrapped and three aneurysms without any treatment. The surgical outcome was good in 13 cases, light disability in 3 cases,severe disability in 1 case and death in 1 case. Conclusion Determination of the responsibility aneurysm,clipping the responsibility aneurysm firstly, choise of one -stage operation or two- stage operation according to the sites of aneurysms and the patients condition should be considered to get good outcome. Key words: Intracranial aneurysms; Microsurgery; Treatment outcome

Tratamiento quirúrgico de los aneurismas intracraneales múltiples

Surgical treatment of multiple intracranial aneurysms is always a complex task. To analyze aneurysms characteristics, therapeutic possibilities and surgical outcomes in a series of patients with multiple intracranial aneurysms. Among 514 patients with intracranial aneurysms, there were 113 with multiple aneurysms (21.5%) and 256 sacs: 244 located at the carotid system and 12 in the vertebrobasilar system. Patients were classified in three groups according to Orz criteria. Surgical treatment was performed in one or two stage operations. Patients were at I or II Grades of the World Federation Scale. The Glasgow Outcome Scale was used for evaluating surgical results. Patients sacs rate was 2.3. The location of aneurysms was high in the posterior communicating artery and very low at the middle cerebral artery. 100% of the lesions in Orz group 1, 82% in group 2 and 33% in group 3 were operated on in one stage operation. Postoperative follow-up showed that 79 % of the patients made a completely recovery. Mortality rate was 4.4%. Results were determined by the peculiar characteristics of this series, good preoperative condition and high proportion of one-stage operations.

Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils.

The purpose of this paper is to present the authors' experience with Guglielmi detachable coil (GDC) embolization of multiple intracranial aneurysms and to evaluate the results of this therapy in single-stage procedures. Clinical and angiographic evaluations were performed in 38 consecutive patients with multiple intracranial aneurysms treated by GDC embolization between March 1990 and October 1997. Twenty-nine patients presented with subarachnoid hemorrhage (SAH), four with mass effect, and five were asymptomatic. These 38 patients harbored 101 aneurysms, 79 of which were treated with GDCs, 14 by surgical clipping, and eight were left untreated. Of the GDC-treated lesions, a complete endovascular occlusion was achieved in 55 aneurysms (70%), and 24 (30%) presented neck remnants. Twenty-five patients (66%) underwent GDC embolization of more than one aneurysm in the first session. Eighteen (86%) of 21 patients with acute SAH underwent treatment for all aneurysms within 3 days after admission (15 of 21 in one session). Follow-up angiographic studies in 30 patients demonstrated an unchanged or improved result in 94% of the aneurysms (59 lesions) and coil compaction in 6% (four lesions). The overall clinical outcome was excellent in 34 patients (89%), good in one (3%), fair in one (3%), and death in two (5%). Endovascular treatment of multiple intracranial aneurysms, regardless of their location, with GDCs was performed safely in one session, even during the acute phase of SAH. Treatment of all aneurysms in one session protected the patient from rebleeding and eliminated the risk of mistakenly treating only the unruptured aneurysms.

Surgical treatment of multiple intracranial aneurysms

A retrospective review of 126 patients with multiple aneurysms seen over a 10 year period was undertaken. They had a total of 302 aneurysms. Thirty-seven percent of the patients were males, and 63% were females. Direct operations were performed on 97 cases. Both the ruptured and unruptured aneurysms were treated in 71% (69 of the 97 cases), and only the ruptured aneurysms were treated in 29% (28). In 69 cases in whom both ruptured and unruptured aneurysms were treated, one-stage operations were used for 48 cases, and two-stage operations were used for 21 cases. Thirty-four of the 48 cases, who were treated in one-stage operations, were operated on by day 4 after subarachnoid haemorrhage. In 12 cases, a total of 13 small unruptured aneurysms, which had not been found by preoperative angiograms, were discovered during surgery, and 9 of the 13 were discovered while removing blood clots to reduce cerebral vasospasm. Regardless of the operative method selected and the timing of operations, the surgical outcome of patients with multiple aneurysms was comparable to that of the 228 cases with single aneurysms treated during the same period at the same hospital. The analysis of this study suggest that surgical results for multiple aneurysms are satisfactory, even for early operations. Further, the actual incidence of multiple aneurysms may be higher than has been reported to date because small unruptured aneurysms which have been discovered during clot removal may not have been reported.