Surgery of intracranial aneurysms previously treated endovascularly

Tirakotai, Wuttipong; Sure, Ulrich; Yin, Yuhua; Benes, Ludwig; Schulte, Dirk Michael; Bien, Siegfried; Bertalanffy, Helmut

doi:10.1016/j.clineuro.2007.05.024

Cited by 19 publications

(12 citation statements)

References 20 publications

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“…Over the last two decades, several series have detailed techniques, results, and complications of surgery for previously coiled aneurysms [5,10,11,21,26,30,36]. However, most of these series are small [6,7,13,16,21,34] and it is difficult to have an overall sense of the complications and outcomes for treatment of previously coiled aneurysms. We conducted a systematic review of the literature to evaluate the safety and efficacy of surgical treatment of previously coiled aneurysms analyzing outcomes by aneurysm rupture status, location, timing of treatment and type of surgical therapy.…”

Section: Introductionmentioning

confidence: 98%

Safety and efficacy of microsurgical treatment of previously coiled aneurysms: a systematic review and meta-analysis

et al. 2015

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Our meta-analysis suggests that surgical treatment is safe and effective. Our data indicate that aneurysms that are amenable to direct clipping have superior outcomes. Late surgery was also associated with better clinical outcomes. Surgery of recurrent posterior circulation aneurysms was associated with high rates of morbidity and mortality. Given the characteristics of the included studies, the quality of evidence of this meta-analysis is limited.

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Section: Introductionmentioning

confidence: 98%

Safety and efficacy of microsurgical treatment of previously coiled aneurysms: a systematic review and meta-analysis

et al. 2015

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“…Careful follow-up is needed because subtotal occlusion carries a future risk of growth, recanalization and rupture. [681214252730] …”

Section: Discussionmentioning

confidence: 99%

Balloon-assisted coiling of the proximal lobule of a paraophthalmic aneurysm causing panhypopituitarism: Technical case report

Orozco

Buciuc²

2011

Surg Neurol Int

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Background:We describe an intra-aneurysmal balloon-assisted technique to limit the coil volume in a large bilobulated paraophthalmic aneurysm. Our intent was to reduce the mass effect and presenting symptoms of diabetes insipidus (DI) with hypopituitarism.Case Description:A 32-year-old woman presented with symptoms of DI and her work-up demonstrated hypopituitarism and partial bitemporal visual field defects. Cerebral angiography revealed a large paraophthalmic aneurysm with two distinctive lobules, projecting toward the pituitary fossa. The patient declined craniotomy but consented for endovascular treatment. The plan was to limit the embolization to the proximal lobule only. Initially, we used a dual microcatheter technique with a microcatheter in each lobule. A framing coil in the distal lobule did not prevent coil migration from the proximal lobule. Instead, we elected to use a Hyperform balloon in the distal lobule and were able to successfully coil the proximal lobule only. Her 3-year follow-up angiogram revealed a completely occluded aneurysm. The patient experienced resolution of the DI and improvement of her visual fields. However, she remained in hypopituitarism.Conclusion:Intra-aneurysmal balloon-assisted coiling of proximal aneurysmal lobules might be an alternative for the reduction of mass effect related to the coil mass. Careful follow-up is needed because subtotal occlusion carries a future risk of growth, recanalization and rupture. Unruptured intracranial carotid aneurysms can present with reversible DI and usually permanent pituitary disturbances.

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“…Failure of initial endovascular approach to an aneurysm requires reassessment of clinical data and redesign of treatment strategy. Important considerations include the patient's neurological status and general medical condition, the location and anatomical structure of the aneurysm, the degree of neck occlusion, and the time elapsed since the last endovascular procedure [ 9 , 10 ].…”

Section: Surgical Treatment Of Previously Coiled Aneurysmsmentioning

confidence: 99%

“…They recommend that when coils have been in the aneurysm for a long time, they should be left in place and the neck be allowed to grow before clipping is attempted. Tirakotai and colleagues [ 9 ] reported a recent series of 8 patients who underwent surgical intervention for various indications following endovascular treatment. Complete obliteration was achieved in all cases, with excellent outcome in 6 cases.…”

Section: Surgical Treatment Of Previously Coiled Aneurysmsmentioning

confidence: 99%

Technical challenges to surgical clipping of aneurysmal regrowth with coil herniation following endovascular treatment – a case report

2007

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In recent years, technical developments have made endovascular procedures attractive therapeutic options and enabled the endovascular surgeon to redefine the management of cerebral aneurysms. However, as the number of aneurysms undergoing endovascular therapy has grown, so has the number of patients with incompletely treated aneurysms who are presenting for further management. In cases of failure of endovascular treatment caused by either incomplete occlusion or regrowth of the aneurysm, a complementary treatment is often necessary. Surgical treatment of these patients is challenging. We present a case of a ruptured posterior cerebral artery aneurysm treated initially with endovascular coiling that left behind significant residual aneurysmal sac. Regrowth of the aneurysm documented on follow-up was treated surgically. At surgery, the coil was found to have herniated through the aneurysmal sac into the subarachnoid space, and the aneurysm was successfully clipped without removing the coils. We review the regrowth of aneurysms following endovascular therapy and potential problems and challenges of surgically managing these lesions.

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Surgery of intracranial aneurysms previously treated endovascularly

Cited by 19 publications

References 20 publications

Safety and efficacy of microsurgical treatment of previously coiled aneurysms: a systematic review and meta-analysis

Safety and efficacy of microsurgical treatment of previously coiled aneurysms: a systematic review and meta-analysis

Balloon-assisted coiling of the proximal lobule of a paraophthalmic aneurysm causing panhypopituitarism: Technical case report

Technical challenges to surgical clipping of aneurysmal regrowth with coil herniation following endovascular treatment – a case report

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