Surgical management of intracranial aneurysms previously treated with endovascular therapy

Abstract

Endovascular treatment with coils of cerebral aneurysm is being increasingly used for definitive treatment. An increasing number of patients are coming for surgical intervention either for recurrences, incomplete coil embolization or its complications. Our objective was to assess the surgical management in such patients. This was a retrospective analysis of the patients who were initially treated with endovascular embolization and later managed surgically with clipping either for unsuccessful coiling, recurrence of aneurysm or post-procedural complication, between 2003 and 2007. Anatomical results were excellent in all five patients, and all the aneurysms were totally excluded from the circulation. All patients had good recovery. None of the patients suffered any major intraoperative or postoperative complication. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy is an emerging challenge, but with proper patient selection and careful planning, this subset of aneurysms can be managed with good results.

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

“…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.…”

The combined treatment of stenting and surgery in a giant unruptured aneurysm of the middle cerebral artery

“…We decided finally to adopt a combined strategy that would keep the vascularization during the entire procedure. In the literature, a combined treatment approach for the same aneurysm has been described in the following different situations: (i) Delayed endovascular[ 2 4 17 ] or surgical treatment[ 2 15 17 19 33 ] after previously unsuccessful surgical or endovascular treatment; (ii) temporary endovascular parent artery occlusion during clipping,[ 27 42 43 46 ] and (iii) microsurgical revascularization followed by endovascular parent artery occlusion and flow-redirection techniques. [ 9 17 30 ] In our experience,[ 42 ] we have previously treated a series of eight giant paraclinoid and four vertebro-basilar aneurysms in combination with the neuroradiologist, where an adequate flow allowed a temporary occlusion.…”

Surgical nuances of clipping after coiling: Looking beyond the international subarachnoid aneurysm trial

“…There have been isolated reports in the literature undermining the importance of coil extrusion, migration and mass effect of coil extrusion, migration and mass effect Kumar et al 22 have reported five ruptured aneurysms that were clipped after an unsuccessful EVT. One MCA aneurysm ruptured during coiling, leading to abandonment of the procedure.…”