Background: With improvements in diagnostic methods, the incidence of multiple intracranial aneurysms has increased up to 35%. Factors influential on outcome in multiple intracranial aneurysms are still debatable. We aimed to determine risk factors related to multiple intracranial aneurysms in patients admitted with subarachnoid hemorrhage caused by a ruptured intracranial aneurysm. Material and Methods: This retrospective study was performed on 105 aneurysms of 48 patients diagnosed with multiple aneurysms using charts, records, and film archives among 250 patients admitted to İstanbul Haydarpaşa Numune Training and Research Hospital between January 2003-December 2009 who were examined and treated for subarachnoid hemorrhage. Age, gender, medical history, admission/surgery times, clinical features determined on neurological examination at admission (WFNS Score), amount of blood measured on cranial computed tomographic images (Fisher Score), number of aneurysms and systems to which they belonged, complications, and Glasgow outcome scale indicating the morbidity and mortality were recorded. Results: The mean age was 52.75±14.02(4-90) years. The female/male ratio was 2.2. Most common clinical features were headache (83.7%), and hypertension (56.3%). The most common location was the middle cerebral artery, and aneurysm size was 2-6 mm (66.7%). The most common intervention was an early clipping of as many aneurysms as possible in one session (84.7%). Vasospasm and hydrocephalus were the most common complications (31.1%, 16.6%, respectively). No difference was present between early and late interventions regarding mortality. Glasgow outcome Scale was negatively correlated with Fisher score (r=-0.306), but not with WFNS score. Conclusions: Age, amount of cisternal blood preoperatively, and postoperative vasospasm are risk factors for mortality, but not hypertension and postoperative hydrocephalus. WFNS Scoring system is not a reliable mortality predictor.

No abstract

Petroclival meningiomas arise from the upper two-thirds of the clivus at the petroclival junction and are reached via various approaches. As petroclival meningiomas expand, they displace the brainstem and basilar artery toward the contralateral side. Because of their proximity to critical structures and deep skull base location, surgical treatment is challenging. Although several approaches have been introduced, their rationales vary. Herein, the authors demonstrate microsurgical resection of a large petroclival meningioma via a translabyrinthine approach combined with middle fossa craniotomy. For each approach, the pros and cons should be carefully evaluated based on the patient’s presentation and lesion characteristics. The video can be found here: https://stream.cadmore.media/r10.3171/2022.1.FOCVID21253