title: Clinical analysis and surgical considerations of atherosclerotic cerebral aneurysms: experience of a single center.
abstract: OBJECTIVE
  Atherosclerotic cerebral aneurysms are known to increase occurrence of thromboembolic events and occlusion of perforator vessels intraoperatively due to pathological changes in the vessels themselves. In the current study, we analyzed the points to be considered during surgery for atherosclerotic cerebral aneurysms and the postoperative results.
  
  
  METHODS
  We retrospectively reviewed the medical records, radiological results, and surgical records, including intraoperative video recordings and photographs, of 262 patients who underwent cerebral aneurysm surgery. We then performed a detailed analysis of aneurysm features, surgical methods, and clinical outcomes.
  
  
  RESULTS
  Among 278 aneurysms in 262 patients, 73 aneurysms in 67 patients showed atherosclerotic features (atherosclerotic group, AG), and 205 aneurysms in 195 patients showed no evidence of atherosclerosis (non-atherosclerotic group, NAG). In the AG, clipping with multiple permanent clips was performed in 14 aneurysms, and clip slippage was found in four cases. Six AG cases had a remnant neck after clipping, which was significantly more frequent than in the NAG (p < 0.05). Clinical outcomes and surgery-related complications did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  In the surgical repair of aneurysms, the incidence of ischemia, which is irreversible or severe, might be greater in atherosclerotic than in non-atherosclerotic aneurysms. In addition, multiple clips might be applied to atherosclerotic aneurysms for effective obliteration and an aneurysm neck might be left to avoid a region of atheroma.
authors.affiliation: Department of Neurosurgery, KyungHee University Hospital, Seoul, Korea.
authors.forename: Chang Kyu
authors.initials: CK
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, KyungHee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Hee Sup
authors.identifier: 0000-0002-5286-8448
authors.initials: HS
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, KyungHee University Hospital, Seoul, Korea.
authors.forename: Seok Keun
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, KyungHee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, KyungHee University Hospital at Gangdong, Seoul, Korea.
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Koh
keywords: Intracranial aneurysm; atherosclerosis; surgical procedure