Multiple intracranial aneurysms: Incidence and outcome in a series of 357 patients

Patients with multiple intracranial aneurysms carry an additional risk of poor outcome due to presence of other aneurysms and the complexity of treatment. Patient’s age is crucial in decision making because of its major effect on outcome and mortality. Objectives: The purpose of this study was to assess incidence and outcome in multiple aneurysmal SAH in a series of 357 consecutive patients.Material and method: We retrospectively analyzed a series of 366 patients with ruptured aneurysms treated between Jan 2006 and Dec 2009 in our department. We study the incidence, localization, surgical outcome and treatment method for individualized patients. We analyzed short-term outcome of multiple aneurysm in comparison to the single in accordance to Glasgow Outcome Scale at discharge. Data of all patients with aneurysmal SAH treated between 2006 an 2009 in our department were collected from their chart; operative notes and used to evaluate the incidence and outcome for three patient’s age category. Results: For both single and multiple aneurysms the incidence was significantly higher in women than in men.Outcome differ statistically between patients with multiple and single aneurysms in age groups 40-69 and 70-89 years.Conclusions: The incidence of multiple intracranial aneurysms is higher in women than in men, the site of rupture are different between the two groups in male the site of rupture is dominated by the anterior communicating artery aneurysms while in women it is represented by the internal carotid artery aneurysms.Patients with multiple intracranial aneurysms had a higher mortality than patients harboring single intracranial aneurysms

Comparative study of microsurgery and Gamma-knife surgery in patients with vestibular schwannoma

Vestibular schwannomas (VSs) are benign neoplasms of Schwann cell origin. Although benign in nature, the treatment of vestibular schwannoma remains a challenge for modern neurosurgery. Patients with vestibular schwannomas have several management options including observation, surgical resection, stereotactic radiosurgery, fractionated radiation therapy, or combinations of these.We study two patient groups that have been treated using either Gamma-Knife radiosurery or microneurosurgery. We analyze the criteria for primary referral to one of the therapeutic procedures and look at their results in terms of tumor control and facial nerve function preservation. The surgical group consisted mostly of patients with tumors equal or bigger than 3 cm (70%) out of which 75% showed imagistic or clinical signs of brainstem compression. The radiosurgery group consisted exclusively of tumors smaller than 3 cm. Facial nerve function preservation results were unsatisfactory in the surgical group but were good for the patients referred to radiosurgery.Our results show that tumor size is a major factor in facial nerve function preservation. However for large tumors surgery is the only therapeutic method possible. For those patients with smaller tumors and very good preoperative neurological function radiosurgery should be the therapy of choice, keeping in mind that in 12% of the cases in our series there has been an enlargement in tumor volume that could raise the indication for microneurosurgery