Treatment strategy for multiple intracranial aneurysms: Our experience

Introduction Multiple intracranial aneurysms (MIA) occur in 20%–34% of patients with intracranial aneurysms and are associated with worse prognosis than solitary aneurysms. MIA predominantly affects patients aged 40–60 years, with a higher prevalence in females. Patients aged 45–65 years account for 60% of ruptured cases, representing a high-risk population. Most patients present with two aneurysms, and mirror aneurysms constitute approximately 10%. With the widespread application of CT, CTA and DSA, the detection rate of MIA has increased significantly. Management of MIA remains challenging due to variable number and location, and accurate identification of the ruptured aneurysm is critical to avoid unfavorable outcomes. Limited high-quality controlled cohort studies have clarified independent risk modifiers and long-term functional benchmarks for individualized MIA treatment; this single-center retrospective cohort aims to summarize stratified individualized endovascular and surgical strategies, provide real-world angiographic and functional follow-up data, and benchmark clinical outcomes against contemporary literature to supplement evidence for comprehensive MIA management. Methods We retrospectively analyzed 53 patients with MIA treated at our institution between 2019 and 2025. Treatment strategies, including single-stage or staged procedures, endovascular embolization, surgical clipping, or combined therapy, were determined based on CT and DSA findings. Baseline preoperative neurological function (Hunt-Hess, modified Fisher) and post-operative 3/12/36-month GOS functional status were systematically recorded for all patients. All patients were scheduled for clinical surveillance and angiographic follow-up with DSA to evaluate neurological function and aneurysm status. Results The mean follow-up duration was 34.6 ± 15.3 months (range, 6–78 months), with one patient lost to follow-up. Among the 53 patients, 39 underwent embolization alone, 4 embolization combined with clipping, and 7 clipping alone. Thirty-seven patients received single-stage treatment, 13 staged treatment, and 3 conservative management, with 112 aneurysms treated in total. One patient with multiple aneurysms suffered rupture of the untreated contralateral aneurysm 2 years after target embolization. Among 52 followed-up patients, 32 had GOS >4, 13 GOS 3, and 7 GOS ≤2. Of 42 patients with DSA follow-up, 9 showed partial neck recurrence, 2 of whom were successfully retreated, with no re-hemorrhage detected in initially treated aneurysms. Conclusions Comprehensive evaluation based on aneurysm morphology, location, rupture risk, and patient condition, combined with individualized treatment and regular follow-up, can achieve satisfactory outcomes in patients with MIA. This study's single-center retrospective limitations warrant external validation via prospective multi-center controlled trials to confirm the generalizability of our stratified treatment algorithm.