Microsurgical clipping of previously coiled intracranial aneurysms

• Published in: Clinical neurology and neurosurgery 2013-08, Vol.115 (8), p.1343-1349
• Main Authors: Nakamura, Makoto, Montibeller, Guilherme R, Götz, Friedrich, Krauss, Joachim K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm recurrence; Aneurysms; Blood clots; Cerebral Angiography; Coiling; Device Removal; Endovascular Procedures - methods; Female; Follow-Up Studies; Humans; Intracranial aneurysm; Intracranial Aneurysm - surgery; Intraoperative Period; Male; Medical imaging; Microsurgery - methods; Microsurgical clipping; Middle Aged; Neurology; Neurosurgery; Neurosurgical Procedures - methods; Patients; Recurrence; Reoperation; Subarachnoid hemorrhage; Surgery; Surgical techniques; Veins & arteries
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2012.12.030

Abstract Objective Endovascular coiling techniques for the treatment of intracranial aneurysms have rapidly developed as an alternative option to surgical clipping. A distinct problem after endovascular coiling is the management of a residual aneurysm neck due to incomplete filling, compaction of coils or regrowth of the aneurysm. Treatment options in this situation include surgical clipping, re-coiling, stent implantation or observation. Methods From June 2006 to August 2011, 15 patients underwent surgical clipping of residual or recurrent aneurysms after previous endovascular treatment. The mean age of the patients was 50.6 years (range, 27–85 years). The mean interval between coiling and clipping was 76.5 weeks (range, 0–288 weeks). Results Thirteen patients revealed a regrowth of coiled aneurysms, and in 5 patients compaction of coils was present. Coil extrusion was observed in 9 patients intraoperatively. In case of coil obstruction at the aneurysmal neck during surgery, coils were partially or completely removed. In all cases complete occlusion of the aneurysms was surgically achieved. Conclusion Coiled aneuryms with incomplete occlusion, coil compaction or regrowth of the aneurysmal neck can be successfully treated with microsurgical clipping. Coil extrusion was more often observed intraoperatively than expected. Complete occlusion of the aneurysm can be performed safely, even if loops of coils protrude into the aneurysmal neck. In these cases intraoperative removal of the coils enables secure closure of the aneurysm with a surgical clip.