title: Management of unruptured cerebral aneurysms in patients with polycystic kidney disease.
abstract: BACKGROUND
  Autosomal dominant polycystic kidney disease (PKD) is a hereditary disorder characterized by bilateral multiple renal cysts and early onset chronic renal failure. PKD patients tend to suffer their subarachnoid hemorrhage at a younger age. Unruptured aneurysms in PKD patients are not always innocuous, and proactive treatment has been indicated for these lesions. However, the management of PKD patients undergoing unruptured cerebral aneurysm surgery has been documented on only a few occasions. The purpose of this study was to better define the management of unruptured cerebral aneurysms in patients with PKD.
  
  
  METHODS
  We present a retrospective review of the management of unruptured cerebral aneurysms in 16 patients with PKD. Eight patients were maintained through chronic hemodialysis whereas the remaining 8 patients did not require hemodialysis, at the time of treatment of their cerebral aneurysms. The mean follow-up period was 24 months.
  
  
  RESULTS
  In the nonhemodialysis patients prophylactic hemodialysis was routinely performed after cerebral angiography to prevent deterioration of the pre-existing renal dysfunction. Microsurgical clipping of the aneurysm was performed in 15 patients (7 nonhemodialysis and 8 hemodialysis patients) and intravascular coil embolization was performed in 1 nonhemodialysis patient. One nonhemodialysis patient who underwent microsurgical clipping required a temporary hemodialysis after surgery, but the patient was not shifted to chronic hemodialysis. No patients developed postprocedural complications, and each showed an excellent recovery.
  
  
  CONCLUSIONS
  PKD patients with unruptured cerebral aneurysms can be safely treated with an appropriate treatment strategy including the use of prophylactic hemodialysis.
authors.affiliation: Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Yanaka
authors.forename: Sohji
authors.initials: S
authors.lastname: Nagase
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Asakawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsumaru
authors.forename: Akio
authors.initials: A
authors.lastname: Koyama
authors.forename: Tadao
authors.initials: T
authors.lastname: Nose
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D007668:Kidney / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011315:Preventive Medicine; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome