Introduction: The prevalence of multiple intracranial aneurysms in the general population ranges from 5-34%. Treatment of these aneurysms, especially when they are bilateral, presents a unique decision challenge to the treating neurosurgeon of whether to pursue a contralateral approach(CLA) or staged approach(SA).
Methods: We retrospectively reviewed a prospectively maintained, IRB approved institutional aneurysm database from 1991-2014 to identify all patients treated by the senior author with bilateral anterior circulation aneurysms in locations previously shown to be amenable to the contralateral approach. Patients underwent either 1) the contralateral approach or 2) a staged approach for treatment of all aneurysms. Records were reviewed for demographic data, aneurysm location, subarachnoid hemorrhage(SAH) status, use of temporary clipping, Glasgow outcome scale(GOS), and post-operative complications.
Results: One-hundred and nine patients underwent either the contralateral(n=50) or staged(n=59) approach to treat a total of 126 and 157 aneurysms, respectively. There was no difference between groups for age(p=0.33), sex(p=0.18), race(p>0.99), number of aneurysms(p>0.99), overall ipsilateral(p>0.99) or contralateral(p=0.33) aneurysm location, Hunt&Hess grade(p=0.3), or use of temporary clipping(p=0.39). There was significantly more patients with SAH in those undergoing a SA(p<0.01). Patients with contralateral middle cerebral artery(p<0.01) and contralateral posterior communicating artery(p<0.01) aneurysms were more likely to be treated by a SA. Outcomes, as measured by GOS at discharge and short-term follow-up, were the same regardless of treatment approach for unruptured(p=0.52, p=0.93 respectively) or ruptured(p=0.79, p=0.89 respectively) aneurysms. Similarly, there was no difference in the number of postoperative complications for patients with unrupturedaneurysms(p=0.67) or SAH(p=0.26).
Conclusions: For patients with bilateral anterior circulation aneurysms, the CLA represents a safe alternative to a SA and allows for obliteration of aneurysms with a single surgery. Compared to a SA, the outcomes of patients undergoing a CLA are the same in patients with either unruptured aneurysms or SAH.
Patient Care: When patients are appropriately chosen, the CLA is a safe alternative for the treatment of bilateral anterior circulation aneurysms.
Learning Objectives: By the conclusion of this session, participants should be able to identify that the outcomes of the CLA are similar to a SA for the treatment of bilateral anterior circulation aneurysms.