Abstract
Objective The risk factors, management strategies, and outcomes of patients with multiple intracranial
aneurysms (MIAs) are different compared with that of patients with a single aneurysm.
Data are scarce regarding patients with MIAs from developing countries. The objective
of this study was to describe the clinical characteristics, management strategies,
and outcomes of patients treated microsurgically from Nepal.
Methods The clinical records of patients confirmed to have MIAs and microsurgically clipped
between July 2014 and December 2019 were retrospectively reviewed. Data on demographic
and clinical characteristics, computed tomography findings, multiplicity and location
of aneurysms, management strategies, and the 1-year outcome were abstracted and analyzed.
Results Two hundred cerebral aneurysms were microsurgically clipped in 170 consecutive patients
during the study period. Twenty-six (13.0%) patients harbored 60 aneurysms. The mean
age of the patients was 58.5 (43–73) years. Smoking and hypertension were found in
20 (76.9%) and 16 (61.5%) patients, respectively. The majority of patients [17 (65.4%)]
were in good grades at presentation. Twenty-one patients had two aneurysms, four had
three aneurysms, and one patient had five aneurysms. The middle cerebral artery was
the commonest (20) followed by distal anterior cerebral artery (14) and anterior communicating
artery (13) involved in multiplicity. A single-stage surgery was performed on 17 patients.
Serial clipping was performed in six patients. In three patients, a single aneurysm
on the contralateral side was left untreated for various reasons. The favorable outcome
was achieved in 23 (88.5%) patients whereas three (11.5%) patients had an unfavorable
outcome. One patient died.
Conclusion The demographic and clinical characteristics of patients in our series are comparable
with those described in the published literature from other countries. With an individualized
treatment strategy, an acceptable outcome can be achieved in the majority of the patients.
Keywords
microsurgical clipping - multiple intracranial aneurysms - Nepal - subarachnoid hemorrhage
