Rare cases of multiple unruptured intracranial aneurysms: Illustrative report and review on management options

Introduction: Multiple intracranial aneurysms [MIA] occur in 7% to 34% of patients with intracranial aneurysms. They can be treated with both surgical and endovascular techniques. Here we report 2 cases of multiple intracranial aneurysms with 6 and 7 aneurysms respectively who were treated at our institute by surgery followed by a discussion on incidence, conditions associated with multiple aneurysms, ethnicity and management strategies. Methods: A retrospective analysis of 2 patients with incidentally detected aneurysms with 6 and 7 aneurysms respectively, who were treated with microsurgical clipping was conducted. A systematic search was performed using the PUBMED database and relevant articles were reviewed with particular attention to incidence, associated conditions, risk factors and management strategies. Results: Both the patients were females with incidental detection of the aneurysms. One had 6 and the other had 8 aneurysms respectively. Both patients underwent bilateral pterional craniotomy and clipping of all the aneurysms except for one aneurysm in the cavernous ICA, for which the patient is planned for an endovascular procedure. Both had an uneventful postoperative course with the CT angiogram showing obliteration of all the aneurysms except one. Conclusions: There is a lack of prospective randomized controlled trials to analyse management options, particularly in comparing intervention with conservative management. Most of the available data is retrospective in nature and lacks objective short and long-term outcome analysis. Furthermore, we need randomized trials to directly compare clipping and coiling of multiple unruptured aneurysms to decide the best intervention strategy of this pathology.