title: [The role of endovascular treatment for multiple intracranial aneurysms with subarachnoid hemorrhage].
abstract: In consideration of the treatment for multiple cerebral aneurysms occurring in association with subarachnoid hemorrhage, it is sometimes difficult to determine which therapeutic strategy should be used when it is difficult to detect the ruptured aneurysm by CT or angiography and difficult to clip all the aneurysms using one approach. This study was conducted to examine indications and problems of coil embolization in the acute stage in such a situation, based on our experience in 9 patients. The patients were aged between 29 to 91 years (mean 61.6 years), and the severity on admission was recorded according to the World Federation of Neurosurgical Societies (WFNS) Grade I in 6 patients, Grade II in 2 patients, and grade IV in 1 patient. The number of aneurysms was 2 in 5 patients, 3 in 3 patients, and 4 in 1 patient. Four patients underwent embolization for all the aneurysms simultaneously, 3 patients underwent embolization for a single aneurysm and then underwent clipping of other aneurysms, and 2 patients were considered to be eligible for surgery and underwent clipping, but since no rupture was detected, they underwent embolization for all the remaining aneurysms. Seven patients made satisfactory progress, but 1 patient developed an embolic complication. Another patient developed recurrent hemorrhage from the untreated aneurysm, so additional clipping was performed. Coil embolization is beneficial in that treatment is completed simultaneously, but has problems in that it cannot be determined whether or not the embolized aneurysm is the ruptured one, embolic complications may occur, and long-term prognosis is unknown.
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Hospital. juro@coral.ocn.ne.jp
authors.forename: Juro
authors.initials: J
authors.lastname: Sakurai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ushikoshi
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Terasaka
authors.forename: Ken
authors.initials: K
authors.lastname: Kazumata
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Asaoka
authors.forename: Minoru
authors.initials: M
authors.lastname: Ajiki
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Mutou
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Furusawa
authors.forename: Yuya
authors.initials: Y
authors.lastname: Takagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed