Intracranial Aneurysms: A Review of Endovascular and Surgical Treatment in 248 Patients

Abstract

We reviewed the medium-term results of endovascular treatment of intracranial aneurysms and compared patient selection and results with those of open surgery. Between January 1992 and December 1995, a total of 248 consecutive patients were treated for 297 aneurysms (61 unruptured and 236 ruptured). 162 aneurysms in 142 patients (mean age, 48.5 years) were treated microsurgically and 134 aneurysms in 106 patients (mean age, 54.2 years) were treated by endovascular embolization with Guglielmi detachable coils (GDC). The mean follow-up was 2.6 years (range, 1.5 to 4.5 years). There was no significant difference in patient population and selection in terms of age, sex or location of aneurysms between both methods. Both modalities achieved excellent results (defined as no neurological deficit) in patients with unruptured aneurysms and with no or minor deficits after subarachnoid hemorrhage (SAH) between 71% and 88%. Patients with moderate deficits after SAH had excellent outcomes in 49% after open surgery, and 47% after embolization. Poor grade patients had, equally, as well an acceptable as a pour outcome, between 0% and 50%. There was no significant difference between the outcome of surgical or endovascular patients. We conclude that GDC embolization is not associated with a higher risk of morbidity and mortality than open surgery. This risk may even be lower for lesions in surgically unfavorable locations. The GDC technique is a less invasive, effective option to prevent re-bleeding in early stage, even in poor-grade patients. However, these encouraging medium-term results have to be confirmed by a longer observation period.

Endovascular Treatment of Intracranial Aneurysms With Guglielmi Detachable Coils

“…In our series, 100% returned to independent clinical status, which compares favorably with previous reports, including a surgical series, 6 as shown in Figure 6. 3,6,7 For ruptured aneurysms, clinical outcome correlated strongly with the H&H clinical grade at the time of treatment as previously reported. 3,4,11 Most reports of clinical outcome have been based on short-term follow-up periods of Ͻ2 years.…”

“…Consequently, there exists an interim period when GDCs were used only for patients in whom surgery had failed or was contraindicated because of inaccessibility, poor clinical status after SAH, or significant preexisting medical comorbidities. Despite this selection bias in the early years, our results compare favorably with open surgery in terms of procedure-related morbidity and mortality ( Figure 5), [3][4][5] clinical outcome, 6,7 and delayed rebleeding rate. 8 This report focuses on the angiographic and clinical outcomes of the primary coil embolization procedure.…”

“…Previous authors have reported that 80% to 98.5% 3,6 of patients undergoing endovascular treatment for unruptured aneurysms are independent at the time of hospital discharge. In our series, 100% returned to independent clinical status, which compares favorably with previous reports, including a surgical series, 6 as shown in Figure 6.…”

“…Other authors, including a surgical series, 6 have experienced rebleeding rates of 0.9% to 3.3%. 4,19 The occurrence of rebleeding only 3 months after documentation of complete aneurysm occlusion was unexpected and disappointing.…”

Anesthesia for cerebral aneurysms: a comparison between interventional neuroradiology and surgery

“…[1][2][3][4][5] Initially, aneurysms that were surgically difficult to access, such as those situated in the posterior fossa, were treated by interventional neuroradiology (INR). 6 As well, patients with high-risk medical conditions may benefit from INR as they need not be subjected to the more invasive technique of surgery.…”