title: [Tactics of surgical treatment of patients with unruptured asymptomatic cerebral aneurysms].
abstract: OBJECTIVE
  To clarify the indications for surgical treatment and the principles for choosing a surgical technique for patients with unruptured asymptomatic aneurysms (UAAs) based on the results of direct and endovasal operations performed at the Burdenko Neurosurgical Institute and on the literature data.
  
  
  METHODS
  The study included 694 UAA patients (481 females (69.3%) and 213 males (30.7%)) operated on at the Burdenko Neurosurgical Institute from 1997 to 2013. The patients' age ranged from 1 to 74 years (mean age, 48.3 years). Multiple aneurysms were in 126 (18.2%) patients. Anterior circle of Willis aneurysms were in 92.8% of cases. Among these, internal carotid artery (ICA) aneurysms (46.3%) and middle cerebral artery (MCA) aneurysms (30.8%) were predominant. Microsurgical and endovascular interventions on aneurysms were performed in 665 patients (95.8%).
  
  
  RESULTS
  Complete aneurysm exclusion was achieved in 94.8% of cases. A pronounced neurological deficit developed in 8 (1.2%) patients, and a moderate neurological deficit developed in 62 (9.3%) patients. Postoperative mortality was 0.5%.
  
  
  CONCLUSIONS
  Surgical treatment of UAAs is associated with low disability and mortality rates. All UAAs need to be operated on, especially in young and middle age patients, if surgery is technically possible, and there are no concomitant diseases contraindicating the intervention. The choice of an UAA exclusion technique is made based on the general principles of surgical treatment of cerebral aneurysms. At present, the method of choice is endovascular surgery for most cases of vertebrobasilar basin and ICA aneurysms and a microsurgical intervention for anterior cerebral artery and MCA aneurysms.
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: A S
authors: AS
authors: Kheyreddin
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: Sh Sh
authors: SS
authors: Eliava
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: S B
authors: SB
authors: Yakovlev
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: Yu M
authors: YM
authors: Filatov
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: A N
authors: AN
authors: Kaftanov
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: O B
authors: OB
authors: Belousova
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: I A
authors: IA
authors: Sazonov
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: S R
authors: SR
authors: Arustamyan
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: K G
authors: KG
authors: Mikeladze
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: E Yu
authors: EY
authors: Bukharin
authors: Burdenko Neurosurgical Institute, Moscow, Russia.
authors: P S
authors: PS
authors: Dorokhov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate